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General NPI Number Information
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NPI Number | 1497196372
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Entity Type | Individual
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Provider Name | JUNG MIN OH DMD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 12/12/2018
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Provider Practice Location Address
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Address Line | 6828 COMMERCE ST STE 103
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City | SPRINGFIELD
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State | VA
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Zip | 22150-2603
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Country | US
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Telephone | 703-451-2222
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Fax | 703-451-6906
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Provider Business Mailing Address
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Address Line | 6828 COMMERCE ST STE 103
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City | SPRINGFIELD
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State | VA
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Zip | 22150-2603
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Country | US
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Telephone | 703-451-2222
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Fax | 703-451-6906
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN1001615
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401415164
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 15908
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN19948
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN4097
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License Number State | ME
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Taxonomy #6
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 016-0002134
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License Number State | VT
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