Healthcare Provider Details

I. General information

NPI: 1720785751
Provider Name (Legal Business Name): HAEYOON JUNG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 RIVERSIDE BLVD
SACRAMENTO CA
95818-2237
US

IV. Provider business mailing address

206 22ND AVE
SAN FRANCISCO CA
94121-2116
US

V. Phone/Fax

Practice location:
  • Phone: 860-368-8791
  • Fax:
Mailing address:
  • Phone: 860-368-8791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number111637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: