Provider Demographics
NPI:1205287984
Name:YIM, ALICIA ALINA (DMD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:ALINA
Last Name:YIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:YIM
Other - Last Name:DARAWSHEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:25779 ANDERBY LN
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-1937
Mailing Address - Country:US
Mailing Address - Phone:703-725-8502
Mailing Address - Fax:
Practice Address - Street 1:1600 DUKE ST STE 150
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-6122
Practice Address - Country:US
Practice Address - Phone:703-276-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16220122300000X
PADS0408961223G0001X
VA0401415456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice