MEDICARE: JI MANAGEMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	1410425	VA

General Provider Information

NPI Number	:	1184775397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JI MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	3438 LAUDERDALE DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-7528
Country	:	US
Telephone Number	:	804-360-2100
Fax Number	:	804-360-0734

Provider Business Practice Location Address
First Line	:	3438 LAUDERDALE DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-7528
Country	:	US
Telephone Number	:	804-360-2100
Fax Number	:	804-360-0734

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. JOHN C JI
Credential	:	D.M.D.
Telephone Number	:	804-520-6050

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	08/22/2020

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