Provider Demographics
NPI:1558347690
Name:JUNG, HEKYUNG LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HEKYUNG
Middle Name:LEE
Last Name:JUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 333 BOX 3623
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96251-0037
Mailing Address - Country:US
Mailing Address - Phone:315-737-9292
Mailing Address - Fax:
Practice Address - Street 1:618TH DENTAL CO(AS)/ KOREA DENTAC; UNIT 15660
Practice Address - Street 2:CAMP HUMPHREYS, CARIUS DENTAL CLINIC BLDG 3020
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96271
Practice Address - Country:US
Practice Address - Phone:315-737-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028218L1223P0221X
CA579181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry