King Street Wellness LLC

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

Legal business name

KING STREET WELLNESS LLC

Practice address

4680 King St
Alexandria, VA 22302-1215

Phone

(540) 533-7337

NPI assigned

Apr 26, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Rahel Yirga, MDNPI 1437121910

Title

Owner

Phone

(540) 533-7337

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rahel G Yirga, MD

  • Internal Medicine Physician
  • Sterling, VA
  • NPI 1437121910

  DC

  Medicare reassignment NPD Authorized official
• Mahelet Mamo

  • Family Nurse Practitioner
  • Arlington, VA
  • NPI 1881132439

  DC

  Medicare reassignment NPD

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

{
    "created_epoch": "1714089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714089600000",
    "number": "1619723913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4680 KING ST",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223021215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4680 KING ST",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223021215",
            "telephone_number": "540-533-7337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING STREET WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-26",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A",
        "authorized_official_last_name": "YIRGA",
        "authorized_official_first_name": "RAHEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "540-533-7337",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• King St. Back & Neck Care
• King Street Apothecary
• King Street Apothecary
• King Street Apothecary Inc
• King Street Back & Neck Care
• Aja Lin King
• Danielle King
• Danielle J King, LPC
• Emaan Nasim King, LMSW
• Jacqueline N King, M.D.

• Urgent Care Clinic/Center in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Urgent Care Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.