Provider Demographics
NPI:1134789373
Name:JONG, EUNICE RUBY (DDS)
Entity type:Individual
Prefix:DR
First Name:EUNICE
Middle Name:RUBY
Last Name:JONG
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 1:4332 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-2452
Mailing Address - Country:US
Mailing Address - Phone:310-999-2215
Mailing Address - Fax:
Practice Address - Street 1:9130 ALCOSTA BLVD STE A4
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3849
Practice Address - Country:US
Practice Address - Phone:252-309-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist