Healthcare Provider Details

I. General information

NPI: 1073350021
Provider Name (Legal Business Name): OBUSAN&ONG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 RAY C HUNT DR
CHARLOTTESVILLE VA
22903-2981
US

IV. Provider business mailing address

8906 WISHART RD
HENRICO VA
23229-7149
US

V. Phone/Fax

Practice location:
  • Phone: 804-894-1580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: JANICE ONG
Title or Position: OWNER
Credential: MD
Phone: 804-894-1580