Healthcare Provider Details

I. General information

NPI: 1427992320
Provider Name (Legal Business Name): SJ SAMUEL NAM DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W BROAD ST STE 200
FALLS CHURCH VA
22046-4200
US

IV. Provider business mailing address

101 W BROAD ST STE 200
FALLS CHURCH VA
22046-4200
US

V. Phone/Fax

Practice location:
  • Phone: 571-584-0020
  • Fax: 571-584-0086
Mailing address:
  • Phone: 571-584-0020
  • Fax: 571-584-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SANG-JIN SAMUEL NAM
Title or Position: OWNER
Credential: DDS
Phone: 571-584-0020