Healthcare Provider Details

I. General information

NPI: 1215812458
Provider Name (Legal Business Name): ACTIVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44121 LEESBURG PIKE STE 285
ASHBURN VA
20147-5673
US

IV. Provider business mailing address

42653 WILLOW BEND DR
BRAMBLETON VA
20148-6884
US

V. Phone/Fax

Practice location:
  • Phone: 571-918-0119
  • Fax: 888-507-4671
Mailing address:
  • Phone: 571-918-0119
  • Fax: 888-507-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EMERENCIENNE DEUNGWE YONGA
Title or Position: OWNER / AUTHORIZED OFFICIAL
Credential: MD
Phone: 571-918-0119