Provider Demographics
NPI:1568456861
Name:YI, SU C (MD)
Entity Type:Individual
Prefix:DR
First Name:SU
Middle Name:C
Last Name:YI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:115 PARK ST SE
Mailing Address - Street 2:STE 300
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4653
Mailing Address - Country:US
Mailing Address - Phone:703-255-9100
Mailing Address - Fax:703-255-3457
Practice Address - Street 1:115 PARK ST SE
Practice Address - Street 2:STE 300
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4653
Practice Address - Country:US
Practice Address - Phone:703-255-9100
Practice Address - Fax:703-255-3457
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101227464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA05805147Medicaid
VA05805147Medicaid
VA009047F32Medicare ID - Type Unspecified