Provider Demographics
NPI:1649761834
Name:JEONG, YOON HWAN EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:YOON HWAN
Middle Name:EDWARD
Last Name:JEONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 CANAL ST UNIT 229
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-4331
Mailing Address - Country:US
Mailing Address - Phone:319-541-8679
Mailing Address - Fax:
Practice Address - Street 1:302 MAIN ST # 304
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-5045
Practice Address - Country:US
Practice Address - Phone:978-330-6462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist