Hae Lim Ji, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401417246 Issued in VA

Practice address

1911 Fort Myer Dr Lbby 101
Arlington, VA 22209-1603

Phone

(703) 686-5445

NPI assigned

May 16, 2018

Last updated

May 4, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1932699857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6411 FOUR OAKS LN",
            "city": "BURKE",
            "state": "VA",
            "postal_code": "220154024",
            "telephone_number": "703-307-5618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 FORT MYER DR LBBY 101",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222091603",
            "telephone_number": "703-686-5445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JI",
        "first_name": "HAE LIM",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-16",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02774400",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "060708",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401417246",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geneva Delmar Vorada Jimreivat, SPT
• JK Premium LLC

• General Practice Dentistry in Arlington, VA
• Providers in Arlington, 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 4, 2021; 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.