Healthcare Provider Details

I. General information

NPI: 1861318339
Provider Name (Legal Business Name): JUN YONG JEONG DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CUESTA DR STE 140
MOUNTAIN VIEW CA
94040-3765
US

IV. Provider business mailing address

1565 POPPY WAY
CUPERTINO CA
95014-5306
US

V. Phone/Fax

Practice location:
  • Phone: 628-235-3690
  • Fax:
Mailing address:
  • Phone: 628-235-3690
  • 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: DR. JUN YONG JEONG
Title or Position: OWNER/ PRESIDENT
Credential: DDS
Phone: 628-235-3690