Healthcare Provider Details

I. General information

NPI: 1184775397
Provider Name (Legal Business Name): JI MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3438 LAUDERDALE DR
RICHMOND VA
23233-7528
US

IV. Provider business mailing address

3438 LAUDERDALE DR
RICHMOND VA
23233-7528
US

V. Phone/Fax

Practice location:
  • Phone: 804-360-2100
  • Fax: 804-360-0734
Mailing address:
  • Phone: 804-360-2100
  • Fax: 804-360-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1410425
License Number StateVA

VIII. Authorized Official

Name: DR. JOHN C JI
Title or Position: ORTHODONTIST
Credential: D.M.D.
Phone: 804-520-6050