Provider Demographics
NPI:1326338955
Name:MIKEAL, MIKYUNG
Entity Type:Individual
Prefix:MRS
First Name:MIKYUNG
Middle Name:
Last Name:MIKEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 HARPOON DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-2330
Mailing Address - Country:US
Mailing Address - Phone:540-720-7688
Mailing Address - Fax:
Practice Address - Street 1:2170 HARPOON DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-2330
Practice Address - Country:US
Practice Address - Phone:540-720-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-16
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter