Healthcare Provider Details

I. General information

NPI: 1467218453
Provider Name (Legal Business Name): JUN YONG JEONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 W EL CAMINO REAL STE 1
SUNNYVALE CA
94087-1180
US

IV. Provider business mailing address

1565 POPPY WAY
CUPERTINO CA
95014-5306
US

V. Phone/Fax

Practice location:
  • Phone: 165-028-2555
  • Fax:
Mailing address:
  • Phone: 628-235-3690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: