Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Spine and Sports Regenerative Medicine Institute

Organization Pain Medicine Physician · NPI 1114764107

Spine and Sports Regenerative Medicine Institute is a Pain Medicine Physician in Fairfax, Virginia. Registered with an NPI since 2024.

In the registry since
2024
Specialties on file
2

Practice location Address checks out

10721 Main St Ste 304
Fairfax, VA 22030-6902
Phone: (703) 349-4205
Fax: (703) 349-4205
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Interventional Pain Medicine Physician (primary) Taxonomy 208VP0014X
Pain Medicine Physician Taxonomy 208VP0000X

Record details

NPI number1114764107
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official David Kim — Ceo · (703) 349-4205
Other names Spine And Pain Regenerative Medicine; Spine And Pain Regenerative Medicine
NPI enumeratedJuly 9, 2024
Last updated in NPPESJuly 16, 2024
Certification dateJuly 16, 2024
Mailing address10721 Main St Ste 304, Fairfax, VA 22030-6902

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