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General NPI Number Information
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NPI Number | 1265625099
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Entity Type | Organization
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Legal Business Name | JEON PROF. DENTAL CORPORATION
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 116 W LA HABRA BLVD
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City | LA HABRA
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State | CA
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Zip | 90631-5402
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Country | US
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Telephone | 562-697-7678
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Fax | 562-905-3272
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Provider Business Mailing Address
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Address Line | 116 W LA HABRA BLVD
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City | LA HABRA
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State | CA
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Zip | 90631-5402
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Country | US
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Telephone | 562-697-7678
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Fax | 562-905-3272
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Authorized Official
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Title or Position | CEO
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Name | YEONG ROK JEON
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Credential |
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Telephone | 562-697-7678
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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 | 46270
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License Number State | CA
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