Healthcare Provider Details

I. General information

NPI: 1598494932
Provider Name (Legal Business Name): JONJEI KU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 W MARCH LN
STOCKTON CA
95207-6111
US

IV. Provider business mailing address

2186 BRIAR HILLS CT
SAN JOSE CA
95138-2437
US

V. Phone/Fax

Practice location:
  • Phone: 209-235-0225
  • Fax:
Mailing address:
  • Phone: 408-630-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS109135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: