Healthcare Provider Details

I. General information

NPI: 1124949722
Provider Name (Legal Business Name): ABRAHAM GANGUK JEONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9434 FIRESTONE BLVD
DOWNEY CA
90241-5504
US

IV. Provider business mailing address

10426 FLORA VISTA ST
BELLFLOWER CA
90706-5066
US

V. Phone/Fax

Practice location:
  • Phone: 562-803-9999
  • Fax:
Mailing address:
  • Phone: 562-445-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: