Provider Demographics
NPI:1467510917
Name:JOHN S K HSU DDS AND VIRGINIA G CHIN DDS PC
Entity Type:Organization
Organization Name:JOHN S K HSU DDS AND VIRGINIA G CHIN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-352-2500
Mailing Address - Street 1:10801 MAIN ST
Mailing Address - Street 2:STE 500 AND 600
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-352-2500
Mailing Address - Fax:703-352-4500
Practice Address - Street 1:10801 MAIN ST
Practice Address - Street 2:STE 500 AND 600
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-352-2500
Practice Address - Fax:703-352-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007863122300000X
VA0401007957122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA14639Medicaid
VA14637Medicaid