Healthcare Provider Details

I. General information

NPI: 1801716097
Provider Name (Legal Business Name): JINWOO JEONG DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39560 STEVENSON PL STE 219
FREMONT CA
94539-3074
US

IV. Provider business mailing address

38340 PRINCETON TER # 5
FREMONT CA
94538-1739
US

V. Phone/Fax

Practice location:
  • Phone: 510-794-9999
  • Fax:
Mailing address:
  • Phone: 847-715-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JINWOO JEONG
Title or Position: PRESIDENT
Credential: DMD
Phone: 847-715-8182