Provider Demographics
NPI:1215812458
Name:ACTIVE HEALTH LLC
Entity type:Organization
Organization Name:ACTIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:EMERENCIENNE
Authorized Official - Middle Name:DEUNGWE
Authorized Official - Last Name:YONGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-439-2058
Mailing Address - Street 1:42653 WILLOW BEND DR
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6884
Mailing Address - Country:US
Mailing Address - Phone:919-439-2058
Mailing Address - Fax:
Practice Address - Street 1:42653 WILLOW BEND DR
Practice Address - Street 2:
Practice Address - City:BRAMBLETON
Practice Address - State:VA
Practice Address - Zip Code:20148-6884
Practice Address - Country:US
Practice Address - Phone:919-439-2058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty