Healthcare Provider Details

I. General information

NPI: 1336768753
Provider Name (Legal Business Name): MRS. JIALU LUCY YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24560 SOUTHPOINT DR STE 150
ALDIE VA
20105-3505
US

IV. Provider business mailing address

24560 SOUTHPOINT DR STE 150
ALDIE VA
20105-3505
US

V. Phone/Fax

Practice location:
  • Phone: 703-496-5343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0110009480
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: