NPIMap

Organization Active NPI

Virginia Functional Medicine, Inc

  • Internal Medicine Physician
  • Vienna, VA
National Provider Identifier
1194011783
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101249229 Issued in VA
Legal business name
VIRGINIA FUNCTIONAL MEDICINE, INC
Practice address
410 Pine St SE
Suite 320
Vienna, VA 22180-4861
Phone
(703) 938-1421
Fax
(703) 938-1424
NPI assigned
Jun 22, 2011
Last updated
Jan 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kaj O Christensen
Title
VP
Phone
(703) 938-1421

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 0101249229 VA Primary

Addresses

Primary practice location

410 Pine St SE
Suite 320
Vienna, VA 22180-4861

Mailing address

410 Pine St SE
Suite 320
Vienna, VA 22180-4861
Phone (703) 938-1421

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1194011783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 PINE ST SE",
            "address_2": "SUITE 320",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221804861",
            "telephone_number": "703-938-1421",
            "fax_number": "703-938-1424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 PINE ST SE",
            "address_2": "SUITE 320",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221804861",
            "telephone_number": "703-938-1421",
            "fax_number": "703-938-1424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRGINIA FUNCTIONAL MEDICINE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-22",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "KAJ",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "703-938-1421",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101249229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vienna, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.