Provider Demographics
NPI:1376198846
Name:AHN, JI EUN (NP)
Entity Type:Individual
Prefix:
First Name:JI EUN
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8925 PURPLE LILAC CIR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-5643
Mailing Address - Country:US
Mailing Address - Phone:703-283-8830
Mailing Address - Fax:
Practice Address - Street 1:2000 N BEAUREGARD ST STE 360
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1751
Practice Address - Country:US
Practice Address - Phone:703-615-5465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177987363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care