Provider Demographics
NPI:1922450410
Name:HAN, JUNG SOOK (LMT)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:SOOK
Last Name:HAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 100A-1
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7700 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 100A-1
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2406
Practice Address - Country:US
Practice Address - Phone:703-752-4623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019004519225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1588941934Medicare Oscar/Certification