Healthcare Provider Details

I. General information

NPI: 1700085479
Provider Name (Legal Business Name): OTRADA ADULT DAY HEALTHCARE CENTER,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 AMANDA PL
VIENNA VA
22180-6873
US

IV. Provider business mailing address

8530 AMANDA PL
VIENNA VA
22180-6873
US

V. Phone/Fax

Practice location:
  • Phone: 703-992-6688
  • Fax: 703-942-6776
Mailing address:
  • Phone: 703-942-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONG CHUL CHOI
Title or Position: OWNER
Credential:
Phone: 703-498-0050