Provider Demographics
NPI:1497137509
Name:YANG, BOK SUN (U01896)
Entity Type:Individual
Prefix:
First Name:BOK
Middle Name:SUN
Last Name:YANG
Suffix:
Gender:F
Credentials:U01896
Other - Prefix:
Other - First Name:VIVINA
Other - Middle Name:
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:U01896
Mailing Address - Street 1:7753 PATRIOT DR
Mailing Address - Street 2:17
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4850
Mailing Address - Country:US
Mailing Address - Phone:571-438-8533
Mailing Address - Fax:
Practice Address - Street 1:13301 KARA LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3426
Practice Address - Country:US
Practice Address - Phone:571-438-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01896171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD171100000XOtherACUPUNCTURIST