Provider Demographics
NPI:1366864480
Name:JUNG S PAK DDS PC
Entity Type:Organization
Organization Name:JUNG S PAK DDS PC
Other - Org Name:FAIRFAX DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:SOO
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-691-9740
Mailing Address - Street 1:11001 LEE HWY STE A
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5018
Mailing Address - Country:US
Mailing Address - Phone:703-691-9740
Mailing Address - Fax:703-691-9809
Practice Address - Street 1:11001 LEE HWY STE A
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5018
Practice Address - Country:US
Practice Address - Phone:703-691-9740
Practice Address - Fax:703-691-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental