Provider Demographics
NPI:1336480888
Name:JOO, SANGBUM (DC)
Entity Type:Individual
Prefix:
First Name:SANGBUM
Middle Name:
Last Name:JOO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LAKEFOREST BLVD STE 395
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2746
Mailing Address - Country:US
Mailing Address - Phone:301-200-8060
Mailing Address - Fax:301-200-8360
Practice Address - Street 1:101 LAKEFOREST BLVD STE 395
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2611
Practice Address - Country:US
Practice Address - Phone:919-402-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4338111N00000X
MDS03901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor