Provider Demographics
NPI:1033347471
Name:RIM, TAE YONG (LAC)
Entity Type:Individual
Prefix:MR
First Name:TAE
Middle Name:YONG
Last Name:RIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:TAE
Other - Middle Name:YONG
Other - Last Name:PAHNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:7535 LITTLE RIVER TNPK. #103A
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:571-287-1764
Mailing Address - Fax:703-595-2125
Practice Address - Street 1:7535 LITTLE RIVER TNPK. #103A
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:571-287-1764
Practice Address - Fax:703-595-2125
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000474171100000X
MDU01585171100000X
DCAC500079171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist