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MANGO WELLNESS
NPI 1992535835
Nurse Practitioner - Family in Fairfax, VA

Active since August 06, 2024CLIA 49D2310566 · Waiver
11166 FAIRFAX BLVD STE 500F38, FAIRFAX, VA 22030(703) 686-5833(703) 635-7127 Get Directions Write a Review

NPPES record last updated: August 15, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 15, 2024, Aug 6, 2024 (2 updates tracked since 2024).

About Mango Wellness NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MANGO WELLNESS (NPI 1992535835) is a healthcare organization registered as a family in Fairfax, Virginia and active in the NPI registry since August 2024. The organization holds a CLIA Waiver certificate valid through September 4, 2026 and lists Hailey Jun, President, as its authorized official.

NPPES Registry Identity

NPI1992535835
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NamePIG LLC
Location Address11166 FAIRFAX BLVD STE 500F38Fairfax, VA 22030-5017
Mailing Address11166 Fairfax Blvd Ste 500f38Fairfax, VA 22030-5017 · (703) 686-5833 · Fax (703) 635-7127
Phone(703) 686-5833
Fax(703) 635-7127
Organization SubpartNo
Authorized OfficialHailey JunPresident · (703) 963-5662
Enumeration DateAugust 6, 2024
Last NPPES UpdateAugust 15, 20242 updates tracked since enumeration
NPPES CertifiedAugust 15, 2024
✔ NPI 1992535835 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
11166 FAIRFAX BLVD STE 500F38, Fairfax, VA 22030
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Other Names 1

Doing Business AsMango Wellness

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D2310566

Mango Wellness · Fairfax, VA
Active · expires Sep 4, 2026
CLIA Number49D2310566
Laboratory TypePractitioner Other
Certificate Effective DateSeptember 5, 2024
Certificate Expiration DateSeptember 4, 2026
Laboratory DirectorHailey H. Jun
Laboratory Phone(703) 686-5833
Laboratory LocationMango Wellness11166 Fairfax Blvd, Suite 500 F46, Fairfax, VA 22030
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HAILEY H JUN FNP-C
Nurse Practitioner (Family)
11166 FAIRFAX BLVD STE 500F38
FAIRFAX, VA 22030
Fairfax City (703) 686-5833

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pig LLC's NPI number?

The NPI number for Pig LLC is 1992535835. It was assigned to this organization in the NPPES registry on August 6, 2024. The provider is doing business as Mango Wellness.

Where is Pig LLC located?

Pig LLC is located at 11166 Fairfax Blvd Ste 500f38, Fairfax, VA 22030. The listed phone number is (703) 686-5833.

What is Pig LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Does Pig LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2310566) is associated with this NPI, valid through September 4, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Pig LLC was last updated on August 15, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.