MRS. MIN JIN JUNG DETRICK (NPI# 1285884007) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285884007 |
| Entity Type | Individual |
| Full Name | MRS. MIN JIN JUNG DETRICK |
| Credential | PA-C |
| Practice Address |
3022 Williams Dr 300 Fairfax VA 22031-4600 |
| Practice Telephone | 7035739800 |
| Practice Fax Number | 7035732959 |
| Mailing Telephone | 7035739800 |
| Mailing Fax Number | 7035732959 |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2011-11-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 0110003714 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 0010-01553 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3022 WILLIAMS DR 300 |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22031-4600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740253020 | Peter Lee Jr. | Pediatrics | 3022 Williams Dr, Suite 301, Fairfax, VA 22031-4600 | 2006-02-08 |
| 1356731822 | Sheryl Kongstvedt | Psychologist | 3022 Williams Dr, Suite 300, Fairfax, VA 22031-4600 | 2015-02-04 |
| 1316283914 | Christiane Gallen Davenport | Nurse Practitioner | 3022 Williams Dr, Suite 300, Fairfax, VA 22031-4600 | 2012-12-31 |
| 1972860807 | Hematology Oncology Care of Northern Virginia PC | Internal Medicine | 3022 Williams Dr, Suite 100, Fairfax, VA 22031-4600 | 2012-04-17 |
| 1346526191 | Kathleen Rodgers | Dietitian, Registered | 3022 Williams Dr, Suite 300, Fairfax, VA 22031-4600 | 2011-10-25 |
| 1831410497 | Thania Violeta Lamirand | Emergency Medicine | 3022 Williams Dr, Suite 300, Fairfax, VA 22031-4600 | 2010-06-17 |
| 1326279043 | Bhavika Amin | Nurse Practitioner | 3022 Williams Dr, #300, Fairfax, VA 22031-4600 | 2009-07-29 |
| 1538308978 | Candice M. Driscoll | Physician Assistant | 3022 Williams Dr, Suite 300, Fairfax, VA 22031-4600 | 2009-02-09 |
| 1982871588 | Seyeda Masomeh Abedi | Internal Medicine | 3022 Williams Dr, Suite 300, Fairfax, VA 22031-4600 | 2008-05-13 |
| 1225221096 | Washington Radiology Associates, Pllc | Specialist | 3022 Williams Dr, Ste 204, Fairfax, VA 22031-4600 | 2007-08-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902414105 | Su Jung Kang | Dentist | 9661-c Main Street, Fairfax, VA 22031 | 2020-07-14 |
| 1346896347 | Fuling Guo | Acupuncturist | 3013 James St, Fairfax, VA 22031 | 2019-08-15 |
| 1902458797 | Kayla Callister | Psychologist | 2270 Willow Oaks Corporate Drive, Fairfax, VA 22031 | 2019-07-11 |
| 1790349801 | Fairfax Dental Esthetics | Dentist | 9621 Fairfax Blvd., Fairfax, VA 22031 | 2019-04-24 |
| 1417427675 | Kathryn Yen Ho | Speech-Language Pathologist | 8270 Willow Oaks Corporate Drive Suite 2127, Falls Church, VA 22031 | 2018-11-30 |
| 1932681376 | Joanne Towers | Physician Assistant | 3025 Hamaker Court Suite 300, Fairfax, VA 22031 | 2018-09-01 |
| 1790262020 | S Renee Dennis | Nurse Practitioner | 8316 Arlington Blvd Ste 500, Fairfax, VA 22031 | 2018-07-19 |
| 1013493451 | Elizabeth Joan Dwyer | Physician Assistant | 3023 Hamaker Ct., Suite 500, Fairfax, VA 22031 | 2018-07-18 |
| 1316432669 | Delta Pharm LLC | Pharmacy | 8316 Arlington Blvd Ste 100, Fairfax, VA 22031 | 2018-06-28 |
| 1629567656 | Laura Breeden | Acupuncturist | 3846 Lyndhurst Dr Apt 301, Fairfax, Va, VA 22031 | 2018-05-04 |
| Find all providers in zip 22031 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053894493 | Natasha Olliver | Physician Assistant | 8500 Executive Park Ave Ste 200, Fairfax, VA 22031-2228 | 2018-09-12 |
| 1932681376 | Joanne Towers | Physician Assistant | 3025 Hamaker Court Suite 300, Fairfax, VA 22031 | 2018-09-01 |
| 1013493451 | Elizabeth Joan Dwyer | Physician Assistant | 3023 Hamaker Ct., Suite 500, Fairfax, VA 22031 | 2018-07-18 |
| 1831692375 | Lauren Mackenzie Mason | Physician Assistant | 3959 Pender Dr Ste 100, Fairfax, VA 22030-6041 | 2018-03-12 |
| 1164949665 | Kaitlyn Burns | Physician Assistant | 3700 Joseph Siewick Dr Ste 404, Fairfax, VA 22033-1745 | 2017-08-25 |
| 1699299628 | Mona Yazdani | Physician Assistant | 2920 District Ave Apt 359, Fairfax, VA 22031-4466 | 2017-08-01 |
| 1518396951 | Samantha Hancock | Physician Assistant | 10721 Main St Ste 200, Fairfax, VA 22030-6913 | 2013-11-06 |
| 1114263613 | Shoshana D Katz | Physician Assistant | 3031 Javier Rd Ste 210, Fairfax, VA 22031-4638 | 2013-01-02 |
| 1770610289 | Sonia J Mabout | Physician Assistant | 2812 Old Lee Hwy # 100b-d, Fairfax, VA 22031-4315 | 2007-02-28 |
| 1396705174 | Stephanie Anne Shepard | Physician Assistant | 2700 Prosperity Ave Ste 270, Fairfax, VA 22031-4321 | 2006-03-24 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.