Healthcare Provider Details

I. General information

NPI: 1679657290
Provider Name (Legal Business Name): EMILY CHIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 WILLIAMS DR SUITE 300
FAIRFAX VA
22031-4600
US

IV. Provider business mailing address

3022 WILLIAMS DR SUITE 300
FAIRFAX VA
22031-4600
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-9800
  • Fax: 703-573-2959
Mailing address:
  • Phone: 703-573-9800
  • Fax: 703-573-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH0064901
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: