Provider Demographics
NPI:1285180638
Name:JANG, JAEWOONG (DMD)
Entity Type:Individual
Prefix:
First Name:JAEWOONG
Middle Name:
Last Name:JANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11050 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5014
Mailing Address - Country:US
Mailing Address - Phone:703-520-6376
Mailing Address - Fax:
Practice Address - Street 1:11050 LEE HWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5014
Practice Address - Country:US
Practice Address - Phone:703-520-6376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10001656122300000X
VA0401415368122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist