Provider Demographics
NPI:1689965683
Name:YI, JISUN (MD)
Entity Type:Individual
Prefix:
First Name:JISUN
Middle Name:
Last Name:YI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JISUN
Other - Middle Name:
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5800 MAPLEDALE PLZ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4535
Mailing Address - Country:US
Mailing Address - Phone:703-670-0067
Mailing Address - Fax:703-670-0301
Practice Address - Street 1:5800 MAPLEDALE PLZ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-4535
Practice Address - Country:US
Practice Address - Phone:703-670-0067
Practice Address - Fax:703-670-0301
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012488892207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism