Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0401412388 | VA |
NPI | 1033369574 |
---|---|
Provider Name | Dr. Steve Juh Lan |
First Address | Ashburn, VA 20148-7160 |
Second Address | Leesburg, VA 20175-4718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2008 |
Last Update Date | 30/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
035518600 | (05) | VA |