Individual
SANG JOONG JEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MEDICAL DOCTOR
Contact information
Practice address
10730 MAIN STREET, FAIRFAX, VA 22030
(301) 317-0020
(301) 317-0028
Mailing address
PO BOX 639, LAUREL, MD 20725-0639
(301) 317-0020
(301) 317-0028
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
010123580
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007
BS INDIVIDUAL
DC
05
—
010051207
—
VA
01
—
112467
ANTHEM
VA
01
—
9105
BS GROUP
DC
Enumeration date
09/26/2006
Last updated
11/28/2012
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