Provider Demographics
NPI:1891226890
Name:JUNG, BETHANY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12777 VALLEY VIEW ST STE 224
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2522
Mailing Address - Country:US
Mailing Address - Phone:714-893-7539
Mailing Address - Fax:
Practice Address - Street 1:12777 VALLEY VIEW ST STE 224
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2522
Practice Address - Country:US
Practice Address - Phone:714-893-7539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist