Provider Demographics
NPI:1740642826
Name:JEONG, JULIA K (DMD, MS)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:K
Last Name:JEONG
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1559
Mailing Address - Country:US
Mailing Address - Phone:562-305-4347
Mailing Address - Fax:
Practice Address - Street 1:21 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1559
Practice Address - Country:US
Practice Address - Phone:562-305-4347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022044122300000X
NY0604001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist