Healthcare Provider Details

I. General information

NPI: 1568578862
Provider Name (Legal Business Name): CHRISTIAN LY CORNEJO YUMPE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 ONTARIO RD NW
WASHINGTON DC
20009-2627
US

IV. Provider business mailing address

601 S CARLIN SPRINGS RD
ARLINGTON VA
22204-1044
US

V. Phone/Fax

Practice location:
  • Phone: 202-545-6800
  • Fax:
Mailing address:
  • Phone: 703-271-8800
  • Fax: 703-271-8585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101240007
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD038358
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: