Individual
JOHNNY KWAN NAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
9561 BRADDOCK RD, FAIRFAX, VA 22032-2539
(703) 323-6500
Mailing address
9561 BRADDOCK RD, FAIRFAX, VA 22032-2539
(703) 323-6500
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401410729
VA
Other
Enumeration date
11/21/2006
Last updated
07/08/2007
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