Provider Demographics
NPI:1578005443
Name:JUNG, DAWOON (NP-C)
Entity type:Individual
Prefix:
First Name:DAWOON
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 DISTRICT AVE APT 611
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4476
Mailing Address - Country:US
Mailing Address - Phone:716-533-0423
Mailing Address - Fax:
Practice Address - Street 1:2920 DISTRICT AVE APT 611
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4476
Practice Address - Country:US
Practice Address - Phone:716-533-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177411363LF0000X
TXAP132558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty