Individual provider Active NPI

Dawoon Jung, NP-C

  • Family Nurse Practitioner
  • Fairfax, VA
National Provider Identifier
1578005443
Registry record updated Jan 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024177411 Issued in VA
Practice address
2920 District Ave Apt 611
Fairfax, VA 22031-4476
Phone
(716) 533-0423
NPI assigned
Nov 9, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 0024177411 VA Primary
Family Nurse Practitioner 363LF0000X AP132558 TX

Addresses

Primary practice location

2920 District Ave Apt 611
Fairfax, VA 22031-4476

Mailing address

2920 District Ave Apt 611
Fairfax, VA 22031-4476
Phone (716) 533-0423

Other practice location 1

4402 Vance Jackson Rd Ste 248
San Antonio, TX 78230-5334
Phone (210) 686-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP132558TXMDFamily Nurse Practitioner
0024177411VAMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1478649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579651200000",
    "number": "1578005443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 DISTRICT AVE APT 611",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314476",
            "telephone_number": "716-533-0423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 DISTRICT AVE APT 611",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314476",
            "telephone_number": "716-533-0423"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4402 Vance Jackson Rd Ste 248",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782305334",
            "country_code": "US",
            "telephone_number": "210-686-5000",
            "fax_number": "210-239-5060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUNG",
        "first_name": "DAWOON",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-09",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024177411",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP132558",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.