Provider Demographics
NPI:1912178815
Name:HAN S. SOH, DDS, PC
Entity Type:Organization
Organization Name:HAN S. SOH, DDS, PC
Other - Org Name:CHANTILLY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-961-1101
Mailing Address - Street 1:4300 CHANTILLY SHOPPING CTR
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-4012
Mailing Address - Country:US
Mailing Address - Phone:703-961-1101
Mailing Address - Fax:
Practice Address - Street 1:4300 CHANTILLY SHOPPING CTR
Practice Address - Street 2:SUITE 1C
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-4012
Practice Address - Country:US
Practice Address - Phone:703-961-1101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014103881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty