Provider Demographics
NPI:1275889024
Name:MUN, JUNGKYUNG J
Entity Type:Individual
Prefix:
First Name:JUNGKYUNG
Middle Name:J
Last Name:MUN
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 1:2655 PROSPERITY AVE APT 118
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2655 PROSPERITY AVE
Practice Address - Street 2:APT 118
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4907
Practice Address - Country:US
Practice Address - Phone:703-973-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist