Active NPI
Nicole Hong
- Dentist
- Chantilly, VA
National Provider Identifier
1154897627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401416255
- Practice address
- 25273 Nesting SQ
Chantilly, VA 20152 - Phone
- (410) 209-7223
- NPI assigned
- Oct 22, 2018
- Reactivated
- Jan 28, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 0401416255 | VA | Primary |
| Dentist | 122300000X | 16626 | MD |
Addresses
Primary practice location
25273 Nesting SQ
Chantilly, VA 20152
Mailing address
4427 Dixie Hill Rd
Apt 209
Fairfax, VA 22030
Phone (571) 338-3104
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401416255 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659312000000",
"number": "1154897627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4427 DIXIE HILL RD",
"address_2": "APT 209",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "22030",
"telephone_number": "571-338-3104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25273 NESTING SQ",
"city": "CHANTILLY",
"state": "VA",
"postal_code": "20152",
"telephone_number": "410-209-7223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HONG",
"first_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-22",
"last_updated": "2022-08-01",
"certification_date": "2022-08-01",
"deactivation_date": "2018-12-19",
"reactivation_date": "2019-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401416255",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "16626",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chantilly, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.