Healthcare Provider Details

I. General information

NPI: 1689235921
Provider Name (Legal Business Name): CHRISTOPHER KIM CHHOUN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 JOSEPH SIEWICK DR STE 308
FAIRFAX VA
22033-1739
US

IV. Provider business mailing address

3700 JOSEPH SIEWICK DR STE 308
FAIRFAX VA
22033-1739
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-8960
  • Fax: 703-828-0961
Mailing address:
  • Phone: 703-698-8960
  • Fax: 703-828-0961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0102210143
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: