Provider Demographics
NPI:1629386966
Name:YEON, TAE HEUM (PHD)
Entity Type:Individual
Prefix:DR
First Name:TAE
Middle Name:HEUM
Last Name:YEON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7345 MCWHORTER PL STE 101
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-5647
Mailing Address - Country:US
Mailing Address - Phone:703-303-1420
Mailing Address - Fax:703-642-6088
Practice Address - Street 1:7345 MCWHORTER PL STE 101
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5647
Practice Address - Country:US
Practice Address - Phone:703-303-1420
Practice Address - Fax:703-642-6088
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000529171100000X
CAAC9582171100000X
ZZ200531141197009171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist