Provider Demographics
NPI:1871142075
Name:JEON, CHAEYEUN (LAC)
Entity type:Individual
Prefix:
First Name:CHAEYEUN
Middle Name:
Last Name:JEON
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12148 GARDEN GROVE CIR UNIT 301
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-9017
Mailing Address - Country:US
Mailing Address - Phone:703-307-7740
Mailing Address - Fax:
Practice Address - Street 1:10301 DEMOCRACY LN STE 110C
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2545
Practice Address - Country:US
Practice Address - Phone:202-743-4122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000936171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist