1033535778 NPI number — BNM, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033535778 NPI number — BNM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BNM, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033535778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12011 LEE JACKSON MEMORIAL HWY
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22033-3310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-865-5437
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12011 LEE JACKSON MEMORIAL HWY
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22033-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-865-5437
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
JUNG
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
SOH YUN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-865-5437

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 556505700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1639326796 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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