Provider Demographics
NPI:1255729299
Name:EUN-SUNG JUNG DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:EUN-SUNG JUNG DDS A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:EUN SUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-868-6202
Mailing Address - Street 1:11832 E. ROSECRANSE AVE.
Mailing Address - Street 2:SUITE #1409
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4107
Mailing Address - Country:US
Mailing Address - Phone:562-868-6202
Mailing Address - Fax:562-868-6115
Practice Address - Street 1:11832 E ROSECRANS AVE.
Practice Address - Street 2:SUITE #1409
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4107
Practice Address - Country:US
Practice Address - Phone:562-868-6202
Practice Address - Fax:562-868-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44193122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty