MEDICARE: JEAN J JOH DDS

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	1223G0001X	General Practice Dentistry	DEN1001066	DC
2	122300000X	Dentist	053078-1	NY
3	122300000X	Dentist	DN18850	FL
4	122300000X	Dentist	9040	NC
5	122300000X	Dentist	0401413124	VA

General Provider Information

NPI Number	:	1740341254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN J JOH DDS

Provider Business Mailing Address
First Line	:	1625 K ST NW STE 575
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20006-1604
Country	:	US
Telephone Number	:	202-223-3325
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 K ST NW STE 575
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20006-1604
Country	:	US
Telephone Number	:	202-223-3325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	08/12/2015

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