Individual
KONSTANTIN SERGEYEVICH GUTNICHENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12011 LEE JACKSON HWY STE 501, FAIRFAX, VA 22033-3315
(703) 259-7027
Mailing address
PO BOX 221135, CHANTILLY, VA 20153-1135
(703) 259-7027
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
0136000798
VA
Other
Enumeration date
07/11/2023
Last updated
07/11/2023
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