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General NPI Number Information
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NPI Number | 1043691769
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Entity Type | Organization
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Legal Business Name | UKJAE JUNG DDS INCORPORATED
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 18102 PIONEER BLVD
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City | ARTESIA
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State | CA
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Zip | 90701
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Country | US
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Telephone | 562-865-9100
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Fax | 562-865-9140
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Provider Business Mailing Address
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Address Line | 18102 PIONEER BLVD
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City | ARTESIA
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State | CA
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Zip | 90701
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Country | US
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Telephone | 562-865-9100
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Fax | 562-865-9140
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Authorized Official
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Title or Position | OWNER
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Name | UKJAE JUNG
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Credential | DDS
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Telephone | 562-865-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 59393
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License Number State | CA
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