Healthcare Provider Details

I. General information

NPI: 1245739762
Provider Name (Legal Business Name): DULLES VEIN AND SURGICAL CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2018
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44355 PREMIER PLZ STE 120
ASHBURN VA
20147-5050
US

IV. Provider business mailing address

25149 DEERHURST TER
CHANTILLY VA
20152-6099
US

V. Phone/Fax

Practice location:
  • Phone: 571-639-9220
  • Fax: 844-965-9773
Mailing address:
  • Phone:
  • Fax: 844-965-9773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number0101259677
License Number StateVA

VIII. Authorized Official

Name: DR. DINGCHAO HE
Title or Position: PROVIDER
Credential: MD
Phone: 202-270-0159