Provider Demographics
NPI:1245533678
Name:YIM, JASON HAESUNG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:HAESUNG
Last Name:YIM
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 1:12821 BRAEMAR VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-5502
Mailing Address - Country:US
Mailing Address - Phone:703-257-0436
Mailing Address - Fax:703-257-4642
Practice Address - Street 1:12821 BRAEMAR VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-5502
Practice Address - Country:US
Practice Address - Phone:703-257-0436
Practice Address - Fax:703-257-4642
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist