Healthcare Provider Details

I. General information

NPI: 1588892335
Provider Name (Legal Business Name): JOOYON BAE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 STAFFORD MARKET PL
STAFFORD VA
22556-4523
US

IV. Provider business mailing address

13544 GRAY BILL CT
CLIFTON VA
20124-0912
US

V. Phone/Fax

Practice location:
  • Phone: 703-868-8918
  • Fax:
Mailing address:
  • Phone: 703-868-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202012085
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: