Provider Demographics
NPI:1023360492
Name:JI WON JUNG, DDS, PC
Entity Type:Organization
Organization Name:JI WON JUNG, DDS, PC
Other - Org Name:NEW SEASON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JI WON
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-334-8779
Mailing Address - Street 1:13640 ORCHARD PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9255
Mailing Address - Country:US
Mailing Address - Phone:720-334-8779
Mailing Address - Fax:720-863-6863
Practice Address - Street 1:13640 ORCHARD PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-9255
Practice Address - Country:US
Practice Address - Phone:720-334-8779
Practice Address - Fax:720-863-6863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10126261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental