Provider Demographics
NPI:1700537750
Name:IM, HYEON
Entity Type:Individual
Prefix:
First Name:HYEON
Middle Name:
Last Name:IM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5004 FRAN PL APT 302
Mailing Address - Street 2:
Mailing Address - City:LINCOLNIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-5086
Mailing Address - Country:US
Mailing Address - Phone:202-815-8084
Mailing Address - Fax:
Practice Address - Street 1:5004 FRAN PL APT 302
Practice Address - Street 2:
Practice Address - City:LINCOLNIA
Practice Address - State:VA
Practice Address - Zip Code:22312-5086
Practice Address - Country:US
Practice Address - Phone:202-815-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist