Provider Demographics
NPI:1922413061
Name:JEONG, JINHOON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JINHOON
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 1:1498 15TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2134
Mailing Address - Country:US
Mailing Address - Phone:310-804-9451
Mailing Address - Fax:
Practice Address - Street 1:200 W RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-3702
Practice Address - Country:US
Practice Address - Phone:610-828-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0400401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice