Healthcare Provider Details

I. General information

NPI: 1215709175
Provider Name (Legal Business Name): HEEJIN YUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 FOLEY ST
SOMERVILLE MA
02145-1266
US

IV. Provider business mailing address

20937 ASHBURN RD STE 200
ASHBURN VA
20147-5663
US

V. Phone/Fax

Practice location:
  • Phone: 571-317-0856
  • Fax:
Mailing address:
  • Phone: 571-317-0856
  • Fax: 571-310-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701015363
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: