Healthcare Provider Details

I. General information

NPI: 1699615559
Provider Name (Legal Business Name): YOUNGSHIN KEUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12755 JEFFERSON AVE
NEWPORT NEWS VA
23602-4317
US

IV. Provider business mailing address

4432 GEORGE WASHINGTON MEM HWY
YORKTOWN VA
23692-2701
US

V. Phone/Fax

Practice location:
  • Phone: 757-877-3147
  • Fax:
Mailing address:
  • Phone: 757-898-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202217640
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH241642
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: