Provider Demographics
NPI:1538709423
Name:JEONG, DAUN (LAC)
Entity type:Individual
Prefix:
First Name:DAUN
Middle Name:
Last Name:JEONG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 WESTMORELAND ST
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4326
Mailing Address - Country:US
Mailing Address - Phone:240-383-8287
Mailing Address - Fax:
Practice Address - Street 1:226 MAPLE AVE W STE 202
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5607
Practice Address - Country:US
Practice Address - Phone:240-383-8287
Practice Address - Fax:703-828-0255
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist