Provider Demographics
NPI:1932654795
Name:YOO, HYUN MIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:HYUN MIN
Middle Name:
Last Name:YOO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43757 PARAMOUNT PL
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-5726
Mailing Address - Country:US
Mailing Address - Phone:770-695-4247
Mailing Address - Fax:
Practice Address - Street 1:5707 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9003
Practice Address - Country:US
Practice Address - Phone:706-322-6253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029060183500000X
VA0202214462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist