Provider Demographics
NPI:1629246814
Name:HA, ROSE JUYOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:JUYOUNG
Last Name:HA
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 1:3927 OLD LEE HWY
Mailing Address - Street 2:SUITE 102 E
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2422
Mailing Address - Country:US
Mailing Address - Phone:703-691-1004
Mailing Address - Fax:703-691-1005
Practice Address - Street 1:3927 OLD LEE HWY
Practice Address - Street 2:SUITE 102 E
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2422
Practice Address - Country:US
Practice Address - Phone:703-691-1004
Practice Address - Fax:703-691-1005
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA40177241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice