PIG LLC NPI 1992535835

NPI Information

  • NPI: 1992535835
  • Provider Name: PIG LLC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • Doing Business As: MANGO WELLNESS
  • CLIA Number: 49D2310566
  • Address: 11166 FAIRFAX BLVD STE 500F38
    FAIRFAX, VA
    ZIP 22030
  • Phone: (703) 686-5833

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NPI Details

PIG LLC is a family nurse practitioner in Fairfax, VA. PIG LLC NPI is 1992535835. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Mango Wellness.

The provider's business location address is:

11166 FAIRFAX BLVD STE 500F38
FAIRFAX, VA
ZIP 22030-017
Phone: (703) 686-5833
Fax: (703) 635-7127

The provider's authorized official is Hailey Jun .
The authorized official title is President and has the following contact phone number (703) 963-5662.

The CLIA number assigned to this NPI record is 49D2310566 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/6/2024 and was last updated on 8/15/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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