1033347471 NPI number — MR. TAE YONG RIM L.AC.

Table of content: MR. TAE YONG RIM L.AC. (NPI 1033347471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033347471 NPI number — MR. TAE YONG RIM L.AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIM
Provider First Name:
TAE
Provider Middle Name:
YONG
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.AC.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAHNG
Provider Other First Name:
TAE
Provider Other Middle Name:
YONG
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.AC.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033347471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7535 LITTLE RIVER TNPK. #103A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNANDALE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-287-1764
Provider Business Mailing Address Fax Number:
703-595-2125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7535 LITTLE RIVER TNPK. #103A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNANDALE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-287-1764
Provider Business Practice Location Address Fax Number:
703-595-2125
Provider Enumeration Date:
06/24/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  0121000474 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: U01585 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X , with the licence number: AC500079 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)