Provider Demographics
NPI:1912511783
Name:BYUN, MATTHEW SUK HO
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SUK HO
Last Name:BYUN
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 1:14300 FALLSMERE CIR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4411
Mailing Address - Country:US
Mailing Address - Phone:703-992-3330
Mailing Address - Fax:
Practice Address - Street 1:701 FAIRFAX PIKE
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-3252
Practice Address - Country:US
Practice Address - Phone:540-869-4130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist