Provider Demographics
NPI:1619432721
Name:BAN, SYLVIA HYEJIN (DMD)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:HYEJIN
Last Name:BAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4042 GUINEA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1413
Mailing Address - Country:US
Mailing Address - Phone:703-909-8829
Mailing Address - Fax:
Practice Address - Street 1:5002 AIRPORT RD NW # 30
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-1607
Practice Address - Country:US
Practice Address - Phone:540-613-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-02
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014164001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice