Healthcare Provider Details

I. General information

NPI: 1497280739
Provider Name (Legal Business Name): IT IS ENT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 MOUNT VERNON AVE SUITE 205
ALEXANDRIA VA
22301-1361
US

IV. Provider business mailing address

PO BOX 30904
ALEXANDRIA VA
22310-8904
US

V. Phone/Fax

Practice location:
  • Phone: 571-447-9136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101256962
License Number StateVA

VIII. Authorized Official

Name: ESTELLE YOO
Title or Position: PRINCIPAL
Credential:
Phone: 571-447-9136