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General NPI Number Information
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NPI Number | 1265511679
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Entity Type | Organization
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Legal Business Name | CHARLES J. JUNG, DMD, A PROFESSIONAL CORP.
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Dates
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Enumeration Date | 11/05/2006
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 1830 W PICO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90006-5018
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Country | US
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Telephone | 213-380-2646
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Fax |
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Provider Business Mailing Address
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Address Line | 1830 W PICO BLVD STE A
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City | LOS ANGELES
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State | CA
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Zip | 90006-5018
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Country | US
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Telephone | 213-380-2646
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES J. JUNG
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Credential | D.M.D.
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Telephone | 213-380-2646
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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 | 34128
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License Number State | CA
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