{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "S. J. LAN DDS PLLC",
"LastName": null,
"FirstName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "22425 BELLE TERRA DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ASHBURN",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "20148-7160",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "240-899-6500",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "43490 YUKON DR STE 105",
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"PracticeLocationAddressCityName": "ASHBURN",
"PracticeLocationAddressStateName": "VA",
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"PracticeLocationAddressTelephoneNumber": "703-771-0007",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/22/2018",
"LastUpdateDate": "07/16/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LAN",
"AuthorizedOfficialFirstName": "STEVE",
"AuthorizedOfficialMiddleName": "J",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "240-899-6500",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "0401412388",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223P0221X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}