Provider Demographics
NPI:1487792602
Name:KUNAISH, SOUSAN H IV (DMD)
Entity type:Individual
Prefix:DR
First Name:SOUSAN
Middle Name:H
Last Name:KUNAISH
Suffix:IV
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8916 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-1511
Mailing Address - Country:US
Mailing Address - Phone:703-448-2626
Mailing Address - Fax:
Practice Address - Street 1:6400 ARLINGTON BLVD STE 744
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2336
Practice Address - Country:US
Practice Address - Phone:703-532-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA80851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice