Active NPI
Yen Logan
- VA Clinic/Center
- Woodbridge, VA
National Provider Identifier
1154870145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- VA Clinic/Center
- License
- 0202205698
- Practice address
- 14139 Potomac Mills Rd
Woodbridge, VA 22192-4644 - Phone
- (703) 490-8400
- NPI assigned
- Oct 1, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| VA Clinic/Center | 261QV0200X | 0202205698 | VA | Primary |
Addresses
Primary practice location
14139 Potomac Mills Rd
Woodbridge, VA 22192-4644
Mailing address
14139 Potomac Mills Rd
Woodbridge, VA 22192-4644
Phone (703) 490-8400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202205698 | VA | MD | VA Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475280000000",
"number": "1154870145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14139 POTOMAC MILLS RD",
"city": "WOODBRIDGE",
"state": "VA",
"postal_code": "221924644",
"telephone_number": "703-490-8400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14139 POTOMAC MILLS RD",
"city": "WOODBRIDGE",
"state": "VA",
"postal_code": "221924644",
"telephone_number": "703-490-8400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOGAN",
"first_name": "YEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-01",
"last_updated": "2016-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "261QV0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, VA",
"state": "VA",
"license": "0202205698",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbridge, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.