Organization
PREMIER BIRTH CENTER CHANTILLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM PEKIN CPM (MANAGING MEMBER)
(240) 422-3889
Entity
Organization
Contact information
Practice address
4200A TECHNOLOGY CT, CHANTILLY, VA 20151-1214
(240) 422-3889
(866) 611-3615
Mailing address
4200A TECHNOLOGY CT, CHANTILLY, VA 20151-1214
(240) 422-3889
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
0129000052
VA
261QB0400X
Birthing Clinic/Center
Primary
—
—
Other
Enumeration date
03/21/2018
Last updated
03/21/2018
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