Active NPI
Jason P. Kiangsoontra, DDS, MS, FACP
- Prosthodontics
- Gainesville, VA
National Provider Identifier
1114364551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 0401415189
- Practice address
- 7521 Virginia Oaks Dr Ste 230
Gainesville, VA 20155-3831 - Phone
- (703) 754-7151
- NPI assigned
- May 24, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | R558 | MN | |
| Prosthodontics | 1223P0700X | 0401415189 | VA | Primary |
Addresses
Primary practice location
7521 Virginia Oaks Dr Ste 230
Gainesville, VA 20155-3831
Mailing address
3148 Goldenwave CT
Fairfax, VA 22031-1863
Other practice location 1
515 Delaware St SE
9-176 Moos Health Science Tower
Minneapolis, MN 55455-0357
Phone (612) 615-3195
Other names 1
- Dr. Jason Kiangsoontra
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170104001305 | VA | Order and Referring Only - Dentist | 3072894187 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R558 | MN | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544227200000",
"number": "1114364551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3148 GOLDENWAVE CT",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220311863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7521 VIRGINIA OAKS DR STE 230",
"city": "GAINESVILLE",
"state": "VA",
"postal_code": "201553831",
"telephone_number": "703-754-7151"
}
],
"practiceLocations": [
{
"address_1": "515 Delaware St SE",
"address_2": "9-176 Moos Health Science Tower",
"address_purpose": "LOCATION",
"city": "Minneapolis",
"state": "MN",
"postal_code": "554550357",
"country_code": "US",
"telephone_number": "612-615-3195",
"fax_number": "612-626-2655",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIANGSOONTRA",
"first_name": "JASON",
"middle_name": "P.",
"name_prefix": "Dr.",
"credential": "DDS, MS, FACP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-05-24",
"last_updated": "2018-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "MN",
"license": "R558",
"primary": false
},
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "VA",
"license": "0401415189",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JASON",
"last_name": "KIANGSOONTRA",
"prefix": "DR.",
"credential": "DDS, MS, FACP",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Gainesville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.