Active NPI
Young Koo
- General Practice Dentistry
- Fairfax, VA
National Provider Identifier
1861776387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 0401413381
- Practice address
- 4138 Fountainside LN
303
Fairfax, VA 22030-7437 - Phone
- (917) 407-4253
- NPI assigned
- Oct 3, 2011
- Last updated
- Oct 3, 2011
- Sex
- Female
- Sole proprietor
- No
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 | 0401413381 | VA | Primary |
Addresses
Primary practice location
4138 Fountainside LN
303
Fairfax, VA 22030-7437
Mailing address
4138 Fountainside LN
303
Fairfax, VA 22030-7437
Phone (917) 407-4253
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 |
|---|---|---|---|
| 0401413381 | VA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317600000000",
"number": "1861776387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4138 FOUNTAINSIDE LN",
"address_2": "303",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220307437",
"telephone_number": "917-407-4253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4138 FOUNTAINSIDE LN",
"address_2": "303",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220307437",
"telephone_number": "917-407-4253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOO",
"first_name": "YOUNG",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-03",
"last_updated": "2011-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "VA",
"license": "0401413381",
"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 Oct 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.