Healthcare Provider Details

I. General information

NPI: 1952689903
Provider Name (Legal Business Name): GABRIELLE K JUNG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 02/07/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NHCP / NMRTC CP 200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

13724 STARLIGHT CT
SAN DIEGO CA
92130-5046
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-7370
  • Fax:
Mailing address:
  • Phone: 720-281-4257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number10510
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10510
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: