Healthcare Provider Details

I. General information

NPI: 1972599249
Provider Name (Legal Business Name): WONSOCK SHIN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 PINE ST SE SUITE 200
VIENNA VA
22180-4861
US

IV. Provider business mailing address

410 PINE ST SE SUITE 200
VIENNA VA
22180-4861
US

V. Phone/Fax

Practice location:
  • Phone: 703-865-8615
  • Fax: 301-777-7455
Mailing address:
  • Phone: 703-865-8615
  • Fax: 301-777-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WONSOCK SHIN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 703-865-8615