Healthcare Provider Details

I. General information

NPI: 1023873502
Provider Name (Legal Business Name): ABC PEDIATRIC URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23634 STRICKLAND DR STE 200
ASHBURN VA
20148-7725
US

IV. Provider business mailing address

23634 STRICKLAND DR STE 110
ASHBURN VA
20148-7727
US

V. Phone/Fax

Practice location:
  • Phone: 703-687-6822
  • Fax: 703-239-7083
Mailing address:
  • Phone: 703-687-6822
  • Fax: 703-239-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EUGENE CHUNG
Title or Position: CEO
Credential: MD
Phone: 571-248-1948