Provider Demographics
NPI:1497965800
Name:OH, JAESUK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAESUK
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4141 N HENDERSON RD
Mailing Address - Street 2:STE 16
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2486
Mailing Address - Country:US
Mailing Address - Phone:703-527-1020
Mailing Address - Fax:703-527-4796
Practice Address - Street 1:4141 N HENDERSON RD
Practice Address - Street 2:STE 16
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-2486
Practice Address - Country:US
Practice Address - Phone:703-527-1020
Practice Address - Fax:703-527-4796
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA77991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice