Healthcare Provider Details

I. General information

NPI: 1316669435
Provider Name (Legal Business Name): YOOJIN KWON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8569 SUDLEY RD STE B
MANASSAS VA
20110-3866
US

IV. Provider business mailing address

2740 PROSPERITY AVE STE 100
FAIRFAX VA
22031-4354
US

V. Phone/Fax

Practice location:
  • Phone: 703-257-7749
  • Fax: 855-254-4529
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185050
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: