Provider Demographics
NPI:1568516573
Name:LUNA, JENNIFER YONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:YONG
Last Name:LUNA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22725 44TH AVE W STE 100
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4583
Mailing Address - Country:US
Mailing Address - Phone:425-412-3955
Mailing Address - Fax:425-967-5583
Practice Address - Street 1:22725 44TH AVE W STE 100
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-4583
Practice Address - Country:US
Practice Address - Phone:425-412-3955
Practice Address - Fax:425-967-5583
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000092781223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice