Healthcare Provider Details

I. General information

NPI: 1811905631
Provider Name (Legal Business Name): EUNJEONG YOON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 INDEPENDENCE BLVD SUITE 2A
VIRGINIA BEACH VA
23455-6010
US

IV. Provider business mailing address

816 INDEPENDENCE BLVD STE 2A
VIRGINIA BEACH VA
23455-6010
US

V. Phone/Fax

Practice location:
  • Phone: 757-363-6712
  • Fax: 757-363-6204
Mailing address:
  • Phone: 757-363-6712
  • Fax: 757-363-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024164530
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: