Healthcare Provider Details

I. General information

NPI: 1083859987
Provider Name (Legal Business Name): CYNTHIA EUNYE CHOI R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EUNRYE CHOI R.D.

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5907 RIDGE FORD DR
BURKE VA
22015-3646
US

IV. Provider business mailing address

5907 RIDGE FORD DR
BURKE VA
22015-3646
US

V. Phone/Fax

Practice location:
  • Phone: 703-403-7310
  • Fax:
Mailing address:
  • Phone: 703-403-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDI100000246
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: