Individual
DR. JASON P. KIANGSOONTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS, FACP
Contact information
Practice address
7521 VIRGINIA OAKS DR STE 230, GAINESVILLE, VA 20155-3831
(703) 754-7151
Mailing address
3148 GOLDENWAVE CT, FAIRFAX, VA 22031-1863
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
0401415189
VA
1223P0700X
Prosthodontics
R558
MN
Other
Enumeration date
05/24/2013
Last updated
12/08/2018
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