Active NPI
Won Heo
- Orthodontics and Dentofacial Orthopedics Dentistry
- Annandale, VA
National Provider Identifier
1992165153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 2018005516
- Practice address
- 4703 Ponderosa Dr
Annandale, VA 22003-4221 - Phone
- (202) 430-6187
- NPI assigned
- Mar 2, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 2018005516 | MO | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
4703 Ponderosa Dr
Annandale, VA 22003-4221
Mailing address
4703 Ponderosa Dr
Annandale, VA 22003-4221
Phone (202) 430-6187
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 |
|---|---|---|---|
| 2018005516 | MO | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679961600000",
"number": "1992165153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4703 PONDEROSA DR",
"city": "ANNANDALE",
"state": "VA",
"postal_code": "220034221",
"telephone_number": "202-430-6187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4703 PONDEROSA DR",
"city": "ANNANDALE",
"state": "VA",
"postal_code": "220034221",
"telephone_number": "202-430-6187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEO",
"first_name": "WON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-03-02",
"last_updated": "2023-03-28",
"certification_date": "2023-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MO",
"license": "2018005516",
"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": []
}Other providers in Annandale, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.