Healthcare Provider Details

I. General information

NPI: 1932948023
Provider Name (Legal Business Name): YOU ARE BEAUTIFUL AESTHETIC INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10721 MAIN ST STE 205
FAIRFAX VA
22030-6902
US

IV. Provider business mailing address

2200 WILSON BLVD # 102-219
ARLINGTON VA
22201-3397
US

V. Phone/Fax

Practice location:
  • Phone: 703-705-2100
  • Fax:
Mailing address:
  • Phone: 703-705-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAE KIM
Title or Position: OWNER
Credential:
Phone: 703-705-2100