Provider Demographics
NPI:1871844423
Name:JEONG, DONGJUN (DDS)
Entity Type:Individual
Prefix:
First Name:DONGJUN
Middle Name:
Last Name:JEONG
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 1:26630 BARTON RD APT 412
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4324
Mailing Address - Country:US
Mailing Address - Phone:951-897-4053
Mailing Address - Fax:
Practice Address - Street 1:26630 BARTON RD APT 412
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4324
Practice Address - Country:US
Practice Address - Phone:951-897-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-23
Last Update Date:2012-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA619311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice