Provider Demographics
NPI:1114058955
Name:JONG, ANTHONY YUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:YUN
Last Name:JONG
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 1:23701 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-6145
Mailing Address - Country:US
Mailing Address - Phone:310-325-5100
Mailing Address - Fax:310-325-5458
Practice Address - Street 1:23000 CRENSHAW BLVD STE 207
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3052
Practice Address - Country:US
Practice Address - Phone:310-325-5100
Practice Address - Fax:310-325-5458
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB390181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice