Provider Demographics
NPI:1144365255
Name:PARK, JAUNG SOON (LAC, DAOM)
Entity type:Individual
Prefix:
First Name:JAUNG SOON
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7535 LITTLE RIVER TPKE STE 200A
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2988
Mailing Address - Country:US
Mailing Address - Phone:703-642-7527
Mailing Address - Fax:
Practice Address - Street 1:7535 LITTLE RIVER TPKE STE 200A
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2988
Practice Address - Country:US
Practice Address - Phone:703-642-7527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000819171100000X
MDU02253171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist