MEDICARE: JUHEE BONG FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024193921	VA

General Provider Information

NPI Number	:	1386533487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUHEE BONG FNP

Provider Business Mailing Address
First Line	:	3535 S BALL ST APT 803
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-4435
Country	:	US
Telephone Number	:	540-686-0307
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 S BALL ST STE A
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-4452
Country	:	US
Telephone Number	:	703-348-9111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	07/02/2025

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