=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124121199
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES WILLIAM HJELM DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1918 OPITZ BLVD
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-494-2144
-----------------------------------------------------
Fax | 703-494-2865
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5215 HOLDEN STREET
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22032-3417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-978-4396
-----------------------------------------------------
Fax | 703-978-4396
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401003967
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------