Healthcare Provider Details

I. General information

NPI: 1639736390
Provider Name (Legal Business Name): YUN HEE JANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8305 GREENSBORO DR
MC LEAN VA
22102-3593
US

IV. Provider business mailing address

8305 GREENSBORO DR
MC LEAN VA
22102-3593
US

V. Phone/Fax

Practice location:
  • Phone: 267-234-2500
  • Fax:
Mailing address:
  • Phone: 267-234-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202217048
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: