Healthcare Provider Details

I. General information

NPI: 1730007832
Provider Name (Legal Business Name): JESSICA JUNG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 TELESTAR CT STE 110
FALLS CHURCH VA
22042-1206
US

IV. Provider business mailing address

9609 GEORGETOWN PIKE
GREAT FALLS VA
22066-2620
US

V. Phone/Fax

Practice location:
  • Phone: 571-596-6477
  • Fax:
Mailing address:
  • Phone: 240-620-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024197942
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: