Provider Demographics
NPI:1578322699
Name:JANG, HEE JOO
Entity Type:Individual
Prefix:
First Name:HEE JOO
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:HEEJOO
Other - Last Name:JANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:14266B WOVEN WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2291
Mailing Address - Country:US
Mailing Address - Phone:703-625-6921
Mailing Address - Fax:
Practice Address - Street 1:14266B WOVEN WILLOW LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2291
Practice Address - Country:US
Practice Address - Phone:703-625-6921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program