Healthcare Provider Details

I. General information

NPI: 1629574678
Provider Name (Legal Business Name): YAMINI KRISHNA KATHARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8081 INNOVATION PARK DR 4TH FLOOR, SKYLINE CLINIC
FAIRFAX VA
22031
US

IV. Provider business mailing address

8081 INNOVATION PARK DR 4TH FLOOR, SKYLINE CLINIC
FAIRFAX VA
22031
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-1390
  • Fax: 571-472-1391
Mailing address:
  • Phone: 571-472-1390
  • Fax: 571-472-1391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number0101286002
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101286002
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number0101286002
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: