Jung Soo Pak, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401414147 Issued in VA

Practice address

11001 Lee Hwy
Suite # a
Fairfax, VA 22030-5018

Phone

(703) 691-9740

Fax

(703) 691-9809

NPI assigned

May 18, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Jung S Pak DDS PC

  • Dental Clinic/Center
  • Fairfax, VA
  • NPI 1366864480
  NPD (past) Authorized official

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

{
    "created_epoch": "1242604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431043200000",
    "number": "1285869495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11001 LEE HWY",
            "address_2": "SUITE # A",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305018",
            "telephone_number": "703-691-9740",
            "fax_number": "703-691-9809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11001 LEE HWY",
            "address_2": "SUITE # A",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305018",
            "telephone_number": "703-691-9740",
            "fax_number": "703-691-9809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAK",
        "first_name": "JUNG",
        "middle_name": "SOO",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-18",
        "last_updated": "2015-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401414147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Nguyen Paglia
• Sharon Pago, MSW, LCSW, LICSW
• Susan D Paige, M.A.
• Pain Relief Treatment Center, LLC
• Tania Estefany Paiz Galeas
• Minoo Pakdaman
• Anastasia Marie Palaia, DPT
• Lisa M Palazzo, M.D.
• Devon Palermo, LPTA, CPT
• Jannen Lee Pallas, CRNA

• General Practice Dentistry in Fairfax, VA
• Providers in Fairfax, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.