Provider Demographics
NPI:1871089987
Name:JUNG, JAE-WOO (DDS)
Entity type:Individual
Prefix:
First Name:JAE-WOO
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7322 PINEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-2726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11864 SUNRISE VALLEY DR STE 100
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3311
Practice Address - Country:US
Practice Address - Phone:703-964-1777
Practice Address - Fax:703-964-1776
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2024-09-30
Deactivation Date:2023-10-13
Deactivation Code:
Reactivation Date:2023-10-20
Provider Licenses
StateLicense IDTaxonomies
VA04014161371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice