Provider Demographics
NPI:1164692448
Name:JAE KWON BOK DDS PC
Entity Type:Organization
Organization Name:JAE KWON BOK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-956-6222
Mailing Address - Street 1:7535 LITTLE RIVER TPKE
Mailing Address - Street 2:#100-E
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2937
Mailing Address - Country:US
Mailing Address - Phone:703-956-6222
Mailing Address - Fax:
Practice Address - Street 1:7535 LITTLE RIVER TPKE
Practice Address - Street 2:100-E
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2937
Practice Address - Country:US
Practice Address - Phone:703-956-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty