Provider Demographics
NPI:1518016377
Name:SONG, JANET KEEJUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:KEEJUNG
Last Name:SONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 OLD LEE HWY
Mailing Address - Street 2:22-D
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2432
Mailing Address - Country:US
Mailing Address - Phone:703-385-1866
Mailing Address - Fax:703-385-5528
Practice Address - Street 1:3915 OLD LEE HWY
Practice Address - Street 2:22-D
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2432
Practice Address - Country:US
Practice Address - Phone:703-385-1866
Practice Address - Fax:703-385-5528
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010070111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice