Provider Demographics
NPI:1205541141
Name:KIM, WAN SUN SUN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:WAN SUN
Middle Name:SUN
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 AQUIA DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-2038
Mailing Address - Country:US
Mailing Address - Phone:540-446-8406
Mailing Address - Fax:
Practice Address - Street 1:1225 AQUIA DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-2038
Practice Address - Country:US
Practice Address - Phone:540-446-8406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70494183500000X
VA0202220875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist