Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 0401411488 | VA |
NPI | 1952314155 |
---|---|
Provider Name | Dr. Jae Min Chong |
First Address | Falls Church, VA 22027 |
Second Address | Falls Church, VA 22027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 08/07/2007 |