Provider Demographics
NPI:1801038567
Name:JUNG, JAE KYUN (DMD)
Entity Type:Individual
Prefix:
First Name:JAE
Middle Name:KYUN
Last Name:JUNG
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 1:2455 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-4341
Mailing Address - Country:US
Mailing Address - Phone:213-453-2195
Mailing Address - Fax:
Practice Address - Street 1:2455 SEPULVEDA BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-4341
Practice Address - Country:US
Practice Address - Phone:213-453-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2014-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60208122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist