Provider Demographics
NPI:1619962263
Name:KOH, HAN-JONG (MD)
Entity Type:Individual
Prefix:DR
First Name:HAN-JONG
Middle Name:
Last Name:KOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:KOH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:224D CORNWALL ST NW
Mailing Address - Street 2:STE 302
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2700
Mailing Address - Country:US
Mailing Address - Phone:703-737-7740
Mailing Address - Fax:888-857-3550
Practice Address - Street 1:224D CORNWALL ST NW
Practice Address - Street 2:STE 302
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2700
Practice Address - Country:US
Practice Address - Phone:703-737-7622
Practice Address - Fax:703-737-7943
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110217163OtherMEDICARE RAILROAD
F88976Medicare UPIN
VA110007785Medicare ID - Type Unspecified