Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101046490 | VA |
NPI | 1003180829 |
---|---|
Provider Name | Ho Chung Tu |
First Address | Fairfax, VA 22030 |
Second Address | Fairfax, VA 22030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2012 |
Last Update Date | 24/02/2012 |