Provider Demographics
NPI:1669534038
Name:J.H.SON, DDS, APC
Entity type:Organization
Organization Name:J.H.SON, DDS, APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEONG HWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-429-1708
Mailing Address - Street 1:1363 OLIVER RD
Mailing Address - Street 2:STE. A
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-3470
Mailing Address - Country:US
Mailing Address - Phone:707-429-1708
Mailing Address - Fax:707-429-1794
Practice Address - Street 1:1363 OLIVER RD
Practice Address - Street 2:STE. A
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-3470
Practice Address - Country:US
Practice Address - Phone:707-429-1708
Practice Address - Fax:707-429-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty