MEDICARE: DIANA H JOO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	0401419374	VA
2	1223P0700X	Prosthodontics	DS044989	PA

General Provider Information

NPI Number	:	1659197770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA H JOO DDS

Provider Business Mailing Address
First Line	:	8304 GREENTREE MANOR LN
Second Line	:
City	:	FAIRFAX STATION
State	:	VA
Zip	:	22039-3214
Country	:	US
Telephone Number	:	703-309-7116
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 COLUMBIA PIKE STE B
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-5867
Country	:	US
Telephone Number	:	703-575-9899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	08/11/2025

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Directions to “ DIANA H JOO DDS” Practice Location

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