Basic Information
Provider Information
NPI: 1972922862
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AN
FirstName: DAVID
MiddleName: INSOO
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8008 WESTPARK DR
Address2:  
City: MCLEAN
State: VA
PostalCode: 22102
CountryCode: US
TelephoneNumber: 7032876400
FaxNumber:  
Practice Location
Address1: 8008 WESTPARK DR
Address2:  
City: MC LEAN
State: VA
PostalCode: 221023109
CountryCode: US
TelephoneNumber: 7032876400
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/08/2014
LastUpdateDate: 06/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/20/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X0101261829VAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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