Provider Demographics
NPI:1952725103
Name:HUH, WOONG (DMD)
Entity Type:Individual
Prefix:DR
First Name:WOONG
Middle Name:
Last Name:HUH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 RIDGE TOP RD
Mailing Address - Street 2:APT 2324
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-1100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12359 SUNRISE VALLEY DR
Practice Address - Street 2:STE 250
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3462
Practice Address - Country:US
Practice Address - Phone:703-388-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-08
Last Update Date:2014-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist