Healthcare Provider Details

I. General information

NPI: 1205287984
Provider Name (Legal Business Name): ALICIA ALINA YIM D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA YIM DARAWSHEH D.M.D.

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DUKE ST STE 150
ALEXANDRIA VA
22314-6122
US

IV. Provider business mailing address

25779 ANDERBY LN
CHANTILLY VA
20152-1937
US

V. Phone/Fax

Practice location:
  • Phone: 703-276-1110
  • Fax:
Mailing address:
  • Phone: 703-725-8502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number16220
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS040896
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401415456
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: