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NPI Code Detail

MEDICARE: DO HYUNG KWON JEONG DMD

MEDICARE: DO HYUNG KWON JEONG DMD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2122300000XDentist38783TX

General Provider Information

NPI Number : 1629661533
Entity Type Code : Individual
Provider Name (Legal Business Name) : DO HYUNG KWON JEONG DMD
Provider Business Mailing Address
First Line : 345 SUNCREST CIR
Second Line :
City : BREA
State : CA
Zip : 92821-4428
Country : US
Telephone Number : 415-516-7390
Fax Number :
Provider Business Practice Location Address
First Line : 6818 ATASCOCITA RD
Second Line :
City : HUMBLE
State : TX
Zip : 77346-2817
Country : US
Telephone Number : 281-446-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2021
Last Update Date : 10/20/2022

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