Provider Demographics
NPI:1821381419
Name:YU, JI YUN (OMD)
Entity Type:Individual
Prefix:DR
First Name:JI YUN
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7236 COLUMBIA PIKE
Mailing Address - Street 2:UNIT C THIRD FLOOR
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3145
Mailing Address - Country:US
Mailing Address - Phone:714-722-0550
Mailing Address - Fax:
Practice Address - Street 1:7236 COLUMBIA PIKE
Practice Address - Street 2:UNIT C THIRD FLOOR
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3145
Practice Address - Country:US
Practice Address - Phone:714-722-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000526171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist