Provider Demographics
NPI:1114015864
Name:YOON, SUNG WON (MD)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:WON
Last Name:YOON
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 1:5041B BACKLICK RD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6046
Mailing Address - Country:US
Mailing Address - Phone:703-914-8778
Mailing Address - Fax:703-914-8777
Practice Address - Street 1:5041B BACKLICK RD
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6046
Practice Address - Country:US
Practice Address - Phone:703-914-8778
Practice Address - Fax:703-914-8777
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039627207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC415369Medicare ID - Type Unspecified
VAD66464Medicare UPIN