Healthcare Provider Details

I. General information

NPI: 1710478292
Provider Name (Legal Business Name): MICHELLE YEUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4231 MARKHAM ST STE 224
ANNANDALE VA
22003-3023
US

IV. Provider business mailing address

4231 MARKHAM ST STE 224
ANNANDALE VA
22003-3023
US

V. Phone/Fax

Practice location:
  • Phone: 703-266-2220
  • Fax:
Mailing address:
  • Phone: 703-266-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019016300
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: