Provider Demographics
NPI:1831882737
Name:JEUNG, SUJIN
Entity type:Individual
Prefix:
First Name:SUJIN
Middle Name:
Last Name:JEUNG
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 1:43077 HUNTERS GREEN SQ
Mailing Address - Street 2:
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4054
Mailing Address - Country:US
Mailing Address - Phone:301-789-3272
Mailing Address - Fax:
Practice Address - Street 1:21750 RED RUM DR STE 117
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5867
Practice Address - Country:US
Practice Address - Phone:703-574-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant