Provider Demographics
NPI:1558838268
Name:LA LUNA LLC
Entity Type:Organization
Organization Name:LA LUNA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUNG IM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:571-395-8413
Mailing Address - Street 1:7002 LITTLE RIVER TPKE STE J
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3200
Mailing Address - Country:US
Mailing Address - Phone:571-395-8413
Mailing Address - Fax:571-395-8289
Practice Address - Street 1:7002 LITTLE RIVER TPKE STE J
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3200
Practice Address - Country:US
Practice Address - Phone:571-395-8413
Practice Address - Fax:571-395-8289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty