MEDICARE: MIN CHUL JUNG DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1316583321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIN CHUL JUNG DDS INC

Provider Business Mailing Address
First Line	:	1535 E HIGHLAND AVE STE F
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4682
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 E HIGHLAND AVE STE F
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4682
Country	:	US
Telephone Number	:	909-356-6852
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MIN CHUL JUNG
Credential	:
Telephone Number	:	714-724-2893

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	11/25/2019

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