Provider Demographics
NPI:1962799866
Name:KIM, NA-YOUNG
Entity type:Individual
Prefix:DR
First Name:NA-YOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 SUDLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-3428
Mailing Address - Country:US
Mailing Address - Phone:703-392-3634
Mailing Address - Fax:703-392-3634
Practice Address - Street 1:8340 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3428
Practice Address - Country:US
Practice Address - Phone:703-392-3634
Practice Address - Fax:703-392-3634
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist