Provider Demographics
NPI:1194366252
Name:KO, EUN JOO
Entity Type:Individual
Prefix:
First Name:EUN JOO
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25446 STALLION BRANCH TER
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-5809
Mailing Address - Country:US
Mailing Address - Phone:703-625-3981
Mailing Address - Fax:
Practice Address - Street 1:25446 STALLION BRANCH TER
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-5809
Practice Address - Country:US
Practice Address - Phone:703-625-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider