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General NPI Number Information
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NPI Number | 1265198295
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Entity Type | Organization
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Legal Business Name | JUNG YOON CHANG DENTAL CORP
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Dates
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Enumeration Date | 11/14/2021
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Last Update Date | 11/14/2021
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Provider Practice Location Address
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Address Line | 952 S ATLANTIC BLVD STE A
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City | LOS ANGELES
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State | CA
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Zip | 90022-4091
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Country | US
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Telephone | 323-263-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 180 HAYDEN WAY
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City | BREA
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State | CA
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Zip | 92821-2323
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Country | US
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Telephone | 909-348-3721
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JUNG YOON CHANG
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Credential | DDS
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Telephone | 909-348-3721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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