Healthcare Provider Details

I. General information

NPI: 1013498211
Provider Name (Legal Business Name): JIHEE WON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6383 ATLANTIC AVE
BELL CA
90201-1227
US

IV. Provider business mailing address

1014 E MANCHESTER AVE STE H
LOS ANGELES CA
90001-3772
US

V. Phone/Fax

Practice location:
  • Phone: 323-562-1301
  • Fax:
Mailing address:
  • Phone: 323-996-5211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number103087
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number103087
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: