Healthcare Provider Details

I. General information

NPI: 1538006150
Provider Name (Legal Business Name): JI WOO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6428 GEORGIA AVE NW
WASHINGTON DC
20012-2910
US

IV. Provider business mailing address

3074 FORUM PL
ELLICOTT CITY MD
21042-2590
US

V. Phone/Fax

Practice location:
  • Phone: 202-723-0303
  • Fax:
Mailing address:
  • Phone: 443-980-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN2001679
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: