Healthcare Provider Details

I. General information

NPI: 1407134166
Provider Name (Legal Business Name): JEYOUNG YUN DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14416 JEFFERSON DAVIS HWY STE 12
WOODBRIDGE VA
22191-2890
US

IV. Provider business mailing address

14416 JEFFERSON DAVIS HWY STE 12
WOODBRIDGE VA
22191-2890
US

V. Phone/Fax

Practice location:
  • Phone: 571-572-3274
  • Fax:
Mailing address:
  • Phone: 571-572-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556479
License Number StateVA

VIII. Authorized Official

Name: DR. JEYOUNG YUN
Title or Position: PRESIDENT
Credential:
Phone: 571-572-3274