Provider Demographics
NPI:1467218453
Name:JEONG, JUN YONG (DDS)
Entity Type:Individual
Prefix:
First Name:JUN YONG
Middle Name:
Last Name:JEONG
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 1:215 QUEST PARK ST APT 234
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1491
Mailing Address - Country:US
Mailing Address - Phone:628-235-3690
Mailing Address - Fax:
Practice Address - Street 1:560 N NELLIS BLVD STE E8
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5371
Practice Address - Country:US
Practice Address - Phone:702-459-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV78761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice