Jae-Woo Jung, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401416137 Issued in VA

Practice address

11864 Sunrise Valley Dr Ste 100
Reston, VA 20191-3311

Phone

(703) 964-1777

Fax

(703) 964-1776

NPI assigned

Jul 2, 2018

Reactivated

Oct 20, 2023

Last updated

Sep 30, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in VA

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

Locations

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.

• Pure Dental LLC

  • General Practice Dentistry
  • Reston, VA
  • NPI 1487436556
  NPD Authorized official
• Dentists of Gainesville, PC

  • Dentist
  • Gainesville, VA
  • NPI 1023546611
  NPD (past)

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

{
    "created_epoch": "1530489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1871089987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7322 PINEWOOD ST",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220462726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11864 SUNRISE VALLEY DR STE 100",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201913311",
            "telephone_number": "703-964-1777",
            "fax_number": "703-964-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUNG",
        "first_name": "JAE-WOO",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-07-02",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "deactivation_date": "2023-10-13",
        "reactivation_date": "2023-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401416137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alan None Joshua, M.D.
• Jowdy Chiropractic Center, LLC (Jowdy Wellness Center)
• Juan a Trinidad MD PC
• Juan Jose de Leon Diaz
• Amber June, LCSW, MAC
• Madeline Petrizzi Jurich, LCSW
• Ellen J Kabat, LCSW
• Frouzan Kabiri, FNP
• Parwana Kabiri
• Jyotsna Kachru

• General Practice Dentistry in Reston, VA
• Providers in Reston, 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 Sep 30, 2024; 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.