Healthcare Provider Details

I. General information

NPI: 1831329150
Provider Name (Legal Business Name): YU NINA NIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3914 CENTERVILLE RD
CHANTILLY VA
20151
US

IV. Provider business mailing address

7015 C MANCHESTER BLVD
ALEXANDRIA VA
22310
US

V. Phone/Fax

Practice location:
  • Phone: 703-481-8600
  • Fax: 703-372-5244
Mailing address:
  • Phone: 703-971-6900
  • Fax: 703-372-5244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101254338
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: