Healthcare Provider Details

I. General information

NPI: 1093442766
Provider Name (Legal Business Name): AK ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MAPLE AVE W STE J
VIENNA VA
22180-4309
US

IV. Provider business mailing address

311 MAPLE AVE W STE J
VIENNA VA
22180-4309
US

V. Phone/Fax

Practice location:
  • Phone: 301-377-8306
  • Fax:
Mailing address:
  • Phone: 571-669-4088
  • Fax: 301-597-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANA KIM
Title or Position: ENDODONTIST
Credential: DMD
Phone: 301-366-2237