Provider Demographics
NPI:1134557499
Name:SY-SIONG, JEROME VILLAPA
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:VILLAPA
Last Name:SY-SIONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28891 GLENHEATHER DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5360
Mailing Address - Country:US
Mailing Address - Phone:909-647-5628
Mailing Address - Fax:
Practice Address - Street 1:1111 E TULARE AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4561
Practice Address - Country:US
Practice Address - Phone:909-647-5628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice