Provider Demographics
NPI:1831472059
Name:KWAK, JIHUN (DPT, MSA, LAC)
Entity type:Individual
Prefix:DR
First Name:JIHUN
Middle Name:
Last Name:KWAK
Suffix:
Gender:
Credentials:DPT, MSA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 LITTLE RIVER TPKE STE 335
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3249
Mailing Address - Country:US
Mailing Address - Phone:703-827-3488
Mailing Address - Fax:571-526-5522
Practice Address - Street 1:7010 LITTLE RIVER TPKE STE 335
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3249
Practice Address - Country:US
Practice Address - Phone:703-827-3488
Practice Address - Fax:571-526-5522
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207264225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist