MEDICARE: DR. JASON HAESUNG YIM PHARM.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202207657	VA

General Provider Information

NPI Number	:	1245533678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON HAESUNG YIM PHARM.D

Provider Business Mailing Address
First Line	:	12821 BRAEMAR VILLAGE PLZ
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-5502
Country	:	US
Telephone Number	:	703-257-0436
Fax Number	:	703-257-4642

Provider Business Practice Location Address
First Line	:	12821 BRAEMAR VILLAGE PLZ
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-5502
Country	:	US
Telephone Number	:	703-257-0436
Fax Number	:	703-257-4642

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	12/07/2010

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