Provider Demographics
NPI:1881865723
Name:KIM, JUNG SUK (LAC)
Entity Type:Individual
Prefix:
First Name:JUNG SUK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7004 LITTLE RIVER TPKE STE C
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3201
Mailing Address - Country:US
Mailing Address - Phone:703-916-0303
Mailing Address - Fax:703-658-4881
Practice Address - Street 1:7004 LITTLE RIVER TPKE STE C
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3201
Practice Address - Country:US
Practice Address - Phone:703-916-0303
Practice Address - Fax:703-658-4881
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000455171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist