Provider Demographics
NPI:1780196253
Name:JEONG, JI WOOK (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:JI WOOK
Middle Name:
Last Name:JEONG
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 CAMBRIDGE ST STE 6400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2032
Mailing Address - Country:US
Mailing Address - Phone:713-486-4027
Mailing Address - Fax:
Practice Address - Street 1:7500 CAMBRIDGE ST STE 6400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2032
Practice Address - Country:US
Practice Address - Phone:713-486-4027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335851223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics