Healthcare Provider Details

I. General information

NPI: 1356677306
Provider Name (Legal Business Name): HWANG H. JUNN MD IM/GERI PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 EVERGREEN LANE SUITE 111
ANNANDALE VA
22003-3253
US

IV. Provider business mailing address

4216 EVERGREEN LANE SUITE 111
ANNANDALE VA
22003-3253
US

V. Phone/Fax

Practice location:
  • Phone: 703-468-4462
  • Fax: 703-256-4680
Mailing address:
  • Phone: 703-468-4462
  • Fax: 703-256-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number101242585
License Number StateVA

VIII. Authorized Official

Name: HWANG H JUNN
Title or Position: DOCTOR
Credential: M.D.
Phone: 703-468-4462