Healthcare Provider Details

I. General information

NPI: 1942077888
Provider Name (Legal Business Name): AJ HUH DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 CABOT DR STE 5-155
CORONA CA
92883-7383
US

IV. Provider business mailing address

2780 CABOT DR STE 5-155
CORONA CA
92883-7383
US

V. Phone/Fax

Practice location:
  • Phone: 951-444-8559
  • Fax:
Mailing address:
  • Phone: 951-444-8559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JEE HYE HUH
Title or Position: PEDIATRIC DENTIST/ OWNER
Credential: DMD
Phone: 951-444-8559