Provider Demographics
NPI:1134097967
Name:JEONG, JIHUN
Entity type:Individual
Prefix:
First Name:JIHUN
Middle Name:
Last Name:JEONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7902 TYSONS ONE PL UNIT 2107
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-5234
Mailing Address - Country:US
Mailing Address - Phone:771-200-0972
Mailing Address - Fax:
Practice Address - Street 1:7902 TYSONS ONE PL UNIT 2107
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-5234
Practice Address - Country:US
Practice Address - Phone:771-200-0972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR266927163W00000X
VA0001334341163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse