Provider Demographics
NPI:1841961232
Name:KIM, YISEUL ESTELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:YISEUL
Middle Name:ESTELLE
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 LEE HWY APT 202
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-7753
Mailing Address - Country:US
Mailing Address - Phone:571-641-9833
Mailing Address - Fax:
Practice Address - Street 1:621 E GLEBE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-3045
Practice Address - Country:US
Practice Address - Phone:703-299-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist