Provider Demographics
NPI:1144395781
Name:JI MANAGMENT LLC
Entity Type:Organization
Organization Name:JI MANAGMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:JI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-520-6050
Mailing Address - Street 1:798 SOUTH PARK BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834
Mailing Address - Country:US
Mailing Address - Phone:804-520-6050
Mailing Address - Fax:804-520-9140
Practice Address - Street 1:798 SOUTH PARK BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834
Practice Address - Country:US
Practice Address - Phone:804-520-6050
Practice Address - Fax:804-520-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA104251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty