Healthcare Provider Details

I. General information

NPI: 1699157602
Provider Name (Legal Business Name): JONATHAN MATTHEW HURNG D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 BAY RD
EAST PALO ALTO CA
94303-1312
US

IV. Provider business mailing address

10550 S FOOTHILL BLVD
CUPERTINO CA
95014-3914
US

V. Phone/Fax

Practice location:
  • Phone: 650-289-7700
  • Fax: 650-853-1018
Mailing address:
  • Phone: 408-688-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDL12597
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11688
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number103677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: