Healthcare Provider Details

I. General information

NPI: 1023360492
Provider Name (Legal Business Name): JI WON JUNG, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 W. 120TH AVE STE 230
WESTMINSTER CO
80234
US

IV. Provider business mailing address

2861 W. 120TH AVE STE 230
WESTMINSTER CO
80234
US

V. Phone/Fax

Practice location:
  • Phone: 720-334-8779
  • Fax: 720-863-6863
Mailing address:
  • Phone: 720-334-8779
  • Fax: 720-863-6863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number10126
License Number StateCO

VIII. Authorized Official

Name: JI WON J. JUNG
Title or Position: PRESIDENT/OWNER
Credential: DDS
Phone: 720-334-8779