Provider Demographics
NPI:1831472059
Name:KWAK, JIHUN (DPT)
Entity Type:Individual
Prefix:DR
First Name:JIHUN
Middle Name:
Last Name:KWAK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 JOHN HANCOCK CT
Mailing Address - Street 2:APT 201
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4919
Mailing Address - Country:US
Mailing Address - Phone:571-524-1155
Mailing Address - Fax:571-526-5522
Practice Address - Street 1:4215 EVERGREEN LN
Practice Address - Street 2:SUITE 201
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3210
Practice Address - Country:US
Practice Address - Phone:571-524-1155
Practice Address - Fax:571-526-5522
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029053225100000X
VA2305207264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist