=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467510917
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN S K HSU DDS AND VIRGINIA G CHIN DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 04/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10801 MAIN ST STE 500 AND 600
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-352-2500
-----------------------------------------------------
Fax | 703-352-4500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10801 MAIN ST STE 500 AND 600
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-352-2500
-----------------------------------------------------
Fax | 703-352-4500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT DENTIST
-----------------------------------------------------
Name | VIRGINIA J CHIN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 703-352-2500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401007863
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401007957
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------