Provider Demographics
NPI:1417199639
Name:JONATHAN S. WON DDS INC
Entity Type:Organization
Organization Name:JONATHAN S. WON DDS INC
Other - Org Name:PACIFIC DENTAL CARE/ DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:SUNYONG
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-285-8600
Mailing Address - Street 1:37262 47TH ST E STE 101
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-4482
Mailing Address - Country:US
Mailing Address - Phone:661-285-8600
Mailing Address - Fax:
Practice Address - Street 1:37262 47TH ST E STE 101
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-4482
Practice Address - Country:US
Practice Address - Phone:661-285-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty