Provider Demographics
NPI:1699113159
Name:AHN, SOOYEON CARITAS (DMD)
Entity type:Individual
Prefix:DR
First Name:SOOYEON
Middle Name:CARITAS
Last Name:AHN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6845 ELM ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-6007
Mailing Address - Country:US
Mailing Address - Phone:703-356-7001
Mailing Address - Fax:703-356-7002
Practice Address - Street 1:6845 ELM ST
Practice Address - Street 2:SUITE 450
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6007
Practice Address - Country:US
Practice Address - Phone:703-356-7001
Practice Address - Fax:703-356-7002
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014137931223X0400X
PADS0384961223X0400X
MD149261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics