Provider Demographics
NPI:1366065401
Name:MOUNG, JONATHAN JAEWOO (PHARMD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JAEWOO
Last Name:MOUNG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 FIDLER LN APT 1423
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3461
Mailing Address - Country:US
Mailing Address - Phone:347-831-4485
Mailing Address - Fax:
Practice Address - Street 1:1110 FIDLER LN APT 1423
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3461
Practice Address - Country:US
Practice Address - Phone:347-831-4485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-23
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100002875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist