Active NPI
Dawoon Jung, NP-C
- Family Nurse Practitioner
- Fairfax, VA
National Provider Identifier
1578005443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 0024177411
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 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
| License | State | Type | Specialty |
|---|---|---|---|
| AP132558 | TX | MD | Family Nurse Practitioner |
| 0024177411 | VA | MD | Family 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.