Healthcare Provider Details

I. General information

NPI: 1790893980
Provider Name (Legal Business Name): ELLIE HO-YOUNG MIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 11/27/2023
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 N FAIRFAX DRIVE SUITE 200
ARLINGTON VA
22203
US

IV. Provider business mailing address

3022 WILLIAMS DRIVE SUITE 300
FAIRFAX VA
22031
US

V. Phone/Fax

Practice location:
  • Phone: 703-525-8863
  • Fax: 703-525-2387
Mailing address:
  • Phone: 703-573-9800
  • Fax: 703-573-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101233198
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: