Provider Demographics
NPI:1760478176
Name:YOUK, JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:YOUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12011 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 504
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3310
Mailing Address - Country:US
Mailing Address - Phone:703-391-2031
Mailing Address - Fax:703-273-3943
Practice Address - Street 1:12330 PINECREST RD
Practice Address - Street 2:#250
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1642
Practice Address - Country:US
Practice Address - Phone:703-476-1050
Practice Address - Fax:703-476-7126
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH73440Medicare UPIN
VA014010O42Medicare ID - Type Unspecified