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:
Health care specialties
| Specialty | Code | License # | 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 9 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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