Healthcare Provider Details

I. General information

NPI: 1154216331
Provider Name (Legal Business Name): JUNE NATHAN YI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14325 WILLARD RD STE 203
CHANTILLY VA
20151-2110
US

IV. Provider business mailing address

4951 WESTCROFT BLVD APT 141
CHANTILLY VA
20151-1572
US

V. Phone/Fax

Practice location:
  • Phone: 703-399-2189
  • Fax:
Mailing address:
  • Phone: 757-870-2397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419508
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: