MEDICARE: MS. KUN YI YOU

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	3336C0003X	Community/Retail Pharmacy	14902	MD

General Provider Information

NPI Number	:	1396310736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KUN YI YOU

Provider Business Mailing Address
First Line	:	18111 PRINCE PHILIP DR
Second Line	:	100
City	:	OLNEY
State	:	MD
Zip	:	20832-1513
Country	:	US
Telephone Number	:	949-244-6097
Fax Number	:	301-774-9813

Provider Business Practice Location Address
First Line	:	18111 PRINCE PHILIP DR STE 100
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832-1503
Country	:	US
Telephone Number	:	949-244-6097
Fax Number	:	301-774-9813

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

Provider Enumeration Date	:	05/26/2021
Last Update Date	:	05/26/2021

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