=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952817652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAI N KHAM DMD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2017
-----------------------------------------------------
Last Update Date | 12/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2021 K ST NW STE 412
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20006-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-677-0456
-----------------------------------------------------
Fax | 202-810-9182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10210 BUSHMAN DR
-----------------------------------------------------
City | OAKTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22124-2887
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-505-3938
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | DR. SAI N KHAM
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 202-677-0456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DEN1001122
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------