Healthcare Provider Details

I. General information

NPI: 1720644891
Provider Name (Legal Business Name): JIHEY JEONG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 11/30/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8527 SEPULVEDA BLVD
NORTH HILLS CA
91343-5824
US

IV. Provider business mailing address

2031 S BENTLEY AVE APT 108
LOS ANGELES CA
90025-5649
US

V. Phone/Fax

Practice location:
  • Phone: 818-895-3100
  • Fax:
Mailing address:
  • Phone: 424-653-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number103674
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number103674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: