Individual provider Active NPI

Daseuli Jeong

  • Obesity Medicine (Family Medicine) Physician
  • Fairfax, VA
National Provider Identifier
1366320970
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obesity Medicine (Family Medicine) PhysicianTaxonomy code 207QB0002X
License
0024194635 Issued in VA
Practice address
3903 Fair Ridge Dr Ste 209
Fairfax, VA 22033-2944
Phone
(703) 865-6490
NPI assigned
Aug 22, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obesity Medicine (Family Medicine) Physician 207QB0002X 0024194635 VA Primary

Addresses

Primary practice location

3903 Fair Ridge Dr Ste 209
Fairfax, VA 22033-2944

Mailing address

3903 Fair Ridge Dr Ste 209
Fairfax, VA 22033-2944
Phone (703) 865-6490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20251118004757 DC Practitioner - Nurse Practitioner 9133610017 Reassigns benefits to 1 organization
I20251119002253 VA Practitioner - Nurse Practitioner 9133610017 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians

Practice addresses (Care Compare)

3025 Berkmar Dr
Suite 1
Charlottesville, VA 22901-1456
Phone (434) 973-1831

3903 Fair Ridge Dr
Suite 219
Fairfax, VA 22033-2945
Phone (703) 865-6490

4820 31St St S
Suite B
Arlington, VA 22206-1665
Phone (703) 865-6490

8130 Boone Blvd
Suite 110
Vienna, VA 22182-2640
Phone (571) 982-6636

8644 Sudley Rd
Suite 220
Manassas, VA 20110-4425
Phone (571) 366-8845

9470 Annapolis Rd
Suite 309
Lanham, MD 20706-3022
Phone (202) 832-1800

950 N Glebe Rd
Suite 700
Arlington, VA 22203-4173

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024194635VAMDObesity Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Sep 29, 2025 Accepting new patients
Privia Medical Group, LLC CurrentSince Sep 29, 2025 Accepting new patients
Nova Physician Wellness Center PLLC Past Accepting new patients

Locations

9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800

3903 Fair Ridge Dr
Ste 209
Fairfax, VA 22033
Phone (571) 349-2191

8644 Sudley Rd
#220
Manassas, VA 20110

14010 Smoketown Rd
Ste 105
Woodbridge, VA 22192
Phone (703) 730-4848

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
  • Direct secure messaging: daseuli.jeong.1@8042.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1755820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1366320970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3903 FAIR RIDGE DR STE 209",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332944",
            "telephone_number": "703-865-6490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 FAIR RIDGE DR STE 209",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332944",
            "telephone_number": "703-865-6490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEONG",
        "first_name": "DASEULI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-22",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QB0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Obesity Medicine",
            "state": "VA",
            "license": "0024194635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.