Provider Demographics
NPI:1922657394
Name:HUH, JUNG-HYUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUNG-HYUN
Middle Name:
Last Name:HUH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43100 PALM ROYALE DR APT 1215
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4901
Mailing Address - Country:US
Mailing Address - Phone:917-724-5987
Mailing Address - Fax:
Practice Address - Street 1:71817 HIGHWAY 111 STE 1
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4487
Practice Address - Country:US
Practice Address - Phone:917-724-5987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist