MEDICARE: TEN PRO CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1111111	OTHER	VA	MEDICAL CARE

General Provider Information

NPI Number	:	1861191025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEN PRO CLINIC

Provider Business Mailing Address
First Line	:	4216 EVERGREEN LN STE 121
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-3256
Country	:	US
Telephone Number	:	703-829-6162
Fax Number	:	703-662-6165

Provider Business Practice Location Address
First Line	:	4216 EVERGREEN LN STE 121
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-3256
Country	:	US
Telephone Number	:	703-829-6162
Fax Number	:	703-662-6165

Authorized Official
Title or Position	:	OWNER
Name	:	JIHO CHOI
Credential	:	MD
Telephone Number	:	703-829-6162

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	02/27/2023

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Directions to “TEN PRO CLINIC ” Practice Location

Language	Start Address	Practice Location

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