Provider Demographics
NPI:1114274248
Name:JANG, SEOKWON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEOKWON
Middle Name:
Last Name:JANG
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 1:1821 W COMMONWEALTH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-3034
Mailing Address - Country:US
Mailing Address - Phone:714-869-3043
Mailing Address - Fax:714-869-3051
Practice Address - Street 1:1821 W COMMONWEALTH AVE STE B
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-3034
Practice Address - Country:US
Practice Address - Phone:714-869-3043
Practice Address - Fax:714-869-3051
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice