Provider Demographics
NPI:1760650600
Name:WON, JONATHAN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:S
Last Name:WON
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 1:39522 10TH ST W STE C
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3757
Mailing Address - Country:US
Mailing Address - Phone:661-433-4061
Mailing Address - Fax:661-287-1592
Practice Address - Street 1:39522 10TH ST W STE C
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3757
Practice Address - Country:US
Practice Address - Phone:661-433-4061
Practice Address - Fax:661-287-1592
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice