Active NPI
Rose Juyoung Ha, D.D.S.
- General Practice Dentistry
- Fairfax, VA
National Provider Identifier
1629246814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4017724
- Practice address
- 3927 Old Lee Hwy
Suite 102 E
Fairfax, VA 22030-2422 - Phone
- (703) 691-1004
- Fax
- (703) 691-1005
- NPI assigned
- Feb 11, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4017724 | VA | Primary |
Addresses
Primary practice location
3927 Old Lee Hwy
Suite 102 E
Fairfax, VA 22030-2422
Mailing address
3927 Old Lee Hwy
Suite 102 E
Fairfax, VA 22030-2422
Phone (703) 691-1004
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 13, 2016 through Apr 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4017724 | VA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209600000000",
"number": "1629246814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3927 OLD LEE HWY",
"address_2": "SUITE 102 E",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220302422",
"telephone_number": "703-691-1004",
"fax_number": "703-691-1005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3927 OLD LEE HWY",
"address_2": "SUITE 102 E",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220302422",
"telephone_number": "703-691-1004",
"fax_number": "703-691-1005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HA",
"first_name": "ROSE",
"middle_name": "JUYOUNG",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-11",
"last_updated": "2008-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "VA",
"license": "4017724",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.