Provider Demographics
NPI:1669352738
Name:REVIVA CLINIC
Entity type:Organization
Organization Name:REVIVA CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIHO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-893-4568
Mailing Address - Street 1:5185 MACARTHUR BLVD NW # 713
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3341
Mailing Address - Country:US
Mailing Address - Phone:301-893-4568
Mailing Address - Fax:240-427-9710
Practice Address - Street 1:5185 MACARTHUR BLVD NW # 713
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3341
Practice Address - Country:US
Practice Address - Phone:240-284-9501
Practice Address - Fax:240-427-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty