Healthcare Provider Details

I. General information

NPI: 1811563455
Provider Name (Legal Business Name): JI-YOUNG YOON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2092 GAITHER RD STE 100
ROCKVILLE MD
20850-4016
US

IV. Provider business mailing address

2092 GAITHER RD STE 100
ROCKVILLE MD
20850-4016
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-5200
  • Fax: 301-424-8063
Mailing address:
  • Phone: 301-424-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3383
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number33593
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number06984
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: