Jaewoong Jang, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

0401415368 Issued in VA

Practice address

11050 Lee Hwy
Fairfax, VA 22030-5014

Phone

(703) 520-6376

NPI assigned

Aug 26, 2016

Last updated

Jul 22, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fairfax Modern Dentistry, PC

  dba Fairfax Modern Dentistry

  • Dentist
  • Fairfax, VA
  • NPI 1174011191
  NPD (past)
• Dental Dreams PLLC

  dba Dental Dreams

  • General Practice Dentistry
  • Washington, DC
  • NPI 1003166182
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658448000000",
    "number": "1285180638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11050 LEE HWY",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305014",
            "telephone_number": "703-520-6376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 LEE HWY",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305014",
            "telephone_number": "703-520-6376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANG",
        "first_name": "JAEWOONG",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-26",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "DC",
            "license": "DEN10001656",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401415368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J Lawrence Jamieson, PH.D.
• Traci Denise Jamison
• Dezireh Jamshidarsani, LCSW
• Jan J. Dekker, M.D., L.L.C.
• Veronica Maureen Janer, LCSW
• Sekwon Jang, M.D.
• Abigail Janicki
• Robert Douglas Janke, M.D.
• Monika Katarzyna Jankowski, DVM
• Melissa Ariel Murillo Jankus, PT

• Dentist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; 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.

Verify at the official NPI Registry.