Provider Demographics
NPI:1609372598
Name:JEON, JENNY JAEHEE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:JAEHEE
Last Name:JEON
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:JAEHEE
Other - Middle Name:
Other - Last Name:JEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1011 S SERRANO AVE APT 514
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3872
Mailing Address - Country:US
Mailing Address - Phone:949-812-8540
Mailing Address - Fax:
Practice Address - Street 1:7925 SEVILLE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-7000
Practice Address - Country:US
Practice Address - Phone:844-757-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-01
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105277122300000X, 1223X0400X
FLDN23879122300000X, 1223X0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program