Provider Demographics
NPI:1558540682
Name:CHA, WONJE (DDS)
Entity type:Individual
Prefix:DR
First Name:WONJE
Middle Name:
Last Name:CHA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1964 GALLOWS RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3814
Mailing Address - Country:US
Mailing Address - Phone:703-448-6909
Mailing Address - Fax:703-448-6907
Practice Address - Street 1:1964 GALLOWS RD
Practice Address - Street 2:SUITE 230
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3814
Practice Address - Country:US
Practice Address - Phone:703-448-6909
Practice Address - Fax:703-448-6907
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410250122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist