Healthcare Provider Details

I. General information

NPI: 1689801045
Provider Name (Legal Business Name): YVONNE KOYEN OKOH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 12/05/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251B SARATOGA AVE NE
WASHINGTON DC
20018-1025
US

IV. Provider business mailing address

1251B SARATOGA AVE NE
WASHINGTON DC
20018-1025
US

V. Phone/Fax

Practice location:
  • Phone: 202-469-4699
  • Fax:
Mailing address:
  • Phone: 202-469-4699
  • Fax: 301-215-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116021396
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101256260
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD84196
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: