Provider Demographics
NPI:1083761340
Name:HONG, RICHARD JAE (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAE
Last Name:HONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12861 WILLIAMS MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2985
Mailing Address - Country:US
Mailing Address - Phone:703-481-0381
Mailing Address - Fax:
Practice Address - Street 1:8230 BOONE BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2621
Practice Address - Country:US
Practice Address - Phone:703-626-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014111671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice