Healthcare Provider Details

I. General information

NPI: 1528861192
Provider Name (Legal Business Name): JON CORNELIUS BARONGAN NOCEDA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 TOPANGA CANYON BLVD
WEST HILLS CA
91304-2343
US

IV. Provider business mailing address

625 S BERENDO ST APT 302
LOS ANGELES CA
90005-1737
US

V. Phone/Fax

Practice location:
  • Phone: 818-227-8986
  • Fax:
Mailing address:
  • Phone: 951-491-1029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: