Provider Demographics
NPI:1700186863
Name:JUN, YOUNG JOO
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:JOO
Last Name:JUN
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 1:11710 OLD GEORGETOWN RD APT 906E
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2680
Mailing Address - Country:US
Mailing Address - Phone:240-361-7772
Mailing Address - Fax:
Practice Address - Street 1:5000 BRADLEY BLVD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20815-6559
Practice Address - Country:US
Practice Address - Phone:301-654-4169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist