Provider Demographics
NPI:1609836022
Name:MYONG J CHA DDS PC
Entity Type:Organization
Organization Name:MYONG J CHA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYONG
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-273-5033
Mailing Address - Street 1:3611 CHAIN BRIDGE RD
Mailing Address - Street 2:STE B
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3246
Mailing Address - Country:US
Mailing Address - Phone:703-273-5033
Mailing Address - Fax:703-358-5528
Practice Address - Street 1:3915 OLD LEE HWY
Practice Address - Street 2:22D
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-273-5033
Practice Address - Fax:703-358-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401006594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty