Ko, Su Min

Ko, Su Min is an individual health care provider with primary practice located at 11166 Fairfax Blvd Suite 105, Fairfax VA 22030-5017. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Interventional Pain Medicine, Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Interventional Pain Medicine is his primary health care specialty. Ko, Su Min can be contacted via phone (703) 277-3360.

Contact Information

Primary practice address
11166 Fairfax Blvd Suite 105 Fairfax VA 22030-5017
Phone: (703) 277-3360
Fax: (703) 277-3370
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 0101250991 Virginia
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 2009001606 Missouri
Allopathic & Osteopathic Physicians / Pain Medicine 2081P2900X 2009001606 Missouri
Allopathic & Osteopathic Physicians / Pain Medicine 2081P2900X 0101250991 Virginia

Profile Details

NPI number 1336375450
LBN Legal business name Ko, Su Min
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 3rd, 2009
Last updated Feb 20th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336375450 NPPES
Missouri Other 9496409 AETNA
Missouri Other 98246 AETNA
Missouri Other 2009001606 AETNA
Missouri Other 000000640716 AETNA
Missouri MEDICAID 1336375450 AETNA

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