Healthcare Provider Details

I. General information

NPI: 1134522196
Provider Name (Legal Business Name): WING Y YIP PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12197 SUNSET HILLS RD
RESTON VA
20190-3208
US

IV. Provider business mailing address

12197 SUNSET HILLS RD
RESTON VA
20190-3208
US

V. Phone/Fax

Practice location:
  • Phone: 703-478-9698
  • Fax: 571-306-5525
Mailing address:
  • Phone: 703-478-9698
  • Fax: 571-306-5525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202213251
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: