Healthcare Provider Details

I. General information

NPI: 1861191025
Provider Name (Legal Business Name): TEN PRO CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 EVERGREEN LN STE 121
ANNANDALE VA
22003-3256
US

IV. Provider business mailing address

4216 EVERGREEN LN STE 121
ANNANDALE VA
22003-3256
US

V. Phone/Fax

Practice location:
  • Phone: 703-829-6162
  • Fax: 703-662-6165
Mailing address:
  • Phone: 703-829-6162
  • Fax: 703-662-6165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JIHO CHOI
Title or Position: OWNER
Credential: MD
Phone: 703-829-6162