Provider Demographics
NPI:1265625099
Name:JEON PROF. DENTAL CORPORATION
Entity type:Organization
Organization Name:JEON PROF. DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YEONG
Authorized Official - Middle Name:ROK
Authorized Official - Last Name:JEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-697-7678
Mailing Address - Street 1:116 W LA HABRA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5402
Mailing Address - Country:US
Mailing Address - Phone:562-697-7678
Mailing Address - Fax:562-905-3272
Practice Address - Street 1:116 W LA HABRA BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-5402
Practice Address - Country:US
Practice Address - Phone:562-697-7678
Practice Address - Fax:562-905-3272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46270261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental