Healthcare Provider Details

I. General information

NPI: 1194892547
Provider Name (Legal Business Name): WEON CHEOL JOO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 S HOOVER ST
LOS ANGELES CA
90006-4962
US

IV. Provider business mailing address

1702 S HOOVER ST
LOS ANGELES CA
90006-4962
US

V. Phone/Fax

Practice location:
  • Phone: 213-383-8275
  • Fax: 213-205-8415
Mailing address:
  • Phone: 213-383-8275
  • Fax: 213-205-8415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: