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General NPI Number Information
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NPI Number | 1477285385
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Entity Type | Organization
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Legal Business Name | JL DENTAL GROUP LLC
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 919 W KIRBY AVE
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City | CHAMPAIGN
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State | IL
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Zip | 61821-5121
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Country | US
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Telephone | 217-359-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 919 W KIRBY AVE
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City | CHAMPAIGN
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State | IL
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Zip | 61821-5121
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Country | US
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Telephone | 217-359-2500
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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. KWUNHO JUNG
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Credential | DDS
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Telephone | 217-722-6415
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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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