Provider Demographics
NPI:1942759089
Name:WON JUNG JEONG DDS INC
Entity Type:Organization
Organization Name:WON JUNG JEONG DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WON
Authorized Official - Middle Name:JUNG
Authorized Official - Last Name:JEONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-803-9999
Mailing Address - Street 1:9434 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5504
Mailing Address - Country:US
Mailing Address - Phone:562-803-9999
Mailing Address - Fax:562-803-6369
Practice Address - Street 1:9434 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5504
Practice Address - Country:US
Practice Address - Phone:562-803-9999
Practice Address - Fax:562-803-6369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty