Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 0104556753 | VA |
N | 111NN0400X | Neurology | CH00034663 | WA |
NPI | 1558563502 |
---|---|
Provider Name | Dr. Peter Yonghun Jo |
First Address | Annandale, VA 22003-1709 |
Second Address | Annandale, VA 22003-1709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 28/12/2009 |