Provider Demographics
NPI:1932296159
Name:CLARENDON CLINIC, PC
Entity Type:Organization
Organization Name:CLARENDON CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PHUOC
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-243-0250
Mailing Address - Street 1:1220 N HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-5048
Mailing Address - Country:US
Mailing Address - Phone:703-243-0250
Mailing Address - Fax:703-243-0148
Practice Address - Street 1:1220 N HUDSON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-5048
Practice Address - Country:US
Practice Address - Phone:703-243-0250
Practice Address - Fax:703-243-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty