Centreville Internal Medicine

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

License

0101235830 Issued in VA

Legal business name

CENTREVILLE INTERNAL MEDICINE

Practice address

13880 Braddock Rd Ste 107
Centreville, VA 20121-2460

Phone

(703) 965-0180

Fax

(703) 266-9003

NPI assigned

Jul 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sugkee YounNPI 1053498766

Title

Director

Phone

(703) 965-0180

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sugkee Youn, M.D.

  • Nephrology Physician
  • Centreville, VA
  • NPI 1053498766

  DC

  Medicare reassignment NPD Authorized official
• Young Nam Min, AGPCNP-BC

  • Gerontology Nurse Practitioner
  • Centreville, VA
  • NPI 1861221715
  NPD
• Sung Ryan Shin, PA-C, DHSC

  • Physician Assistant
  • MC Lean, VA
  • NPI 1912220112
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344470400000",
    "number": "1073712352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13880 BRADDOCK RD STE 107",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201212460",
            "telephone_number": "703-965-0180",
            "fax_number": "703-266-9003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13880 BRADDOCK RD STE 107",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201212460",
            "telephone_number": "703-965-0180",
            "fax_number": "703-266-9003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTREVILLE INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-16",
        "last_updated": "2012-08-09",
        "status": "A",
        "authorized_official_last_name": "YOUN",
        "authorized_official_first_name": "SUGKEE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "703-965-0180"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "VA",
            "license": "0101235830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010419719",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Centreville Children'S Dentistry, PC
• Centreville Chiropractic Center
• Centreville Dental Wellness Center,PC.
• Centreville Family Chiropractic
• Centreville Family Practice
• Centreville Medical Practice PLLC
• Centreville Optometry, LLC
• Centreville Pediatric Dentistry PLLC
• Centreville Physical Therapy, PC
• Centreville Women'S Health LLC

• Adult Day Care Clinic/Center in Centreville, VA
• Providers in Centreville, VA by specialty
• Adult Day Care Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.