Provider Demographics
NPI:1497196372
Name:OH, JUNG MIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUNG MIN
Middle Name:
Last Name:OH
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 1:6828 COMMERCE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2603
Mailing Address - Country:US
Mailing Address - Phone:703-451-2222
Mailing Address - Fax:703-451-6906
Practice Address - Street 1:6828 COMMERCE ST STE 103
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2603
Practice Address - Country:US
Practice Address - Phone:703-451-2222
Practice Address - Fax:703-451-6906
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001615122300000X
VA0401415164122300000X
MD15908122300000X
MADN19948122300000X
MEDEN4097122300000X
VT016-0002134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist