Provider Demographics
NPI:1841644952
Name:HAM, LESLIE JUNG
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:JUNG
Last Name:HAM
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 1:7002 LITTLE RIVER TPKE
Mailing Address - Street 2:STE J
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3200
Mailing Address - Country:US
Mailing Address - Phone:703-715-7599
Mailing Address - Fax:571-395-8289
Practice Address - Street 1:7002 LITTLE RIVER TPKE
Practice Address - Street 2:STE J
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3200
Practice Address - Country:US
Practice Address - Phone:703-715-7599
Practice Address - Fax:571-395-8289
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor