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General NPI Number Information
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NPI Number | 1104921063
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Entity Type | Individual
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Provider Name | SUN(SUSAN) W YIM DO
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Gender | Female
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 1149 SEMINOLE TRL
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-2897
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Country | US
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Telephone | 434-978-3998
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Fax |
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Provider Business Mailing Address
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Address Line | 1756 HYLAND CREEK CIR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-3591
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Country | US
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Telephone | 217-840-5841
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102203731
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License Number State | VA
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