Provider Demographics
NPI:1780825406
Name:YOO, JE UN (LAC,MAC,DIP'LAC)
Entity Type:Individual
Prefix:MR
First Name:JE
Middle Name:UN
Last Name:YOO
Suffix:
Gender:M
Credentials:LAC,MAC,DIP'LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 EVERGREEN LN
Mailing Address - Street 2:SUITE 224
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3235
Mailing Address - Country:US
Mailing Address - Phone:703-642-3300
Mailing Address - Fax:
Practice Address - Street 1:4208 EVERGREEN LN
Practice Address - Street 2:SUITE 224
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3235
Practice Address - Country:US
Practice Address - Phone:703-642-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000519171100000X
MDU01636171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU01636OtherSTATE OF MARYLAND BOARD OF ACUPUNCTURE
108692OtherNCCAOM
VA0121000519OtherCOMMONWELTH OF VIRGINIA