Provider Demographics
NPI:1740829688
Name:LUO, JIN
Entity type:Individual
Prefix:
First Name:JIN
Middle Name:
Last Name:LUO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7229 VELLEX LN
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6029
Mailing Address - Country:US
Mailing Address - Phone:571-346-9315
Mailing Address - Fax:
Practice Address - Street 1:3700 JOSEPH SIEWICK DR STE 401
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1745
Practice Address - Country:US
Practice Address - Phone:703-715-9700
Practice Address - Fax:703-715-0202
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174383363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care