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General NPI Number Information
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NPI Number | 1497646871
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Entity Type | Individual
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Provider Name | HEE SEUNG JUNG
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Gender | Male
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 8415 HAVEN AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3893
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Country | US
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Telephone | 909-980-2272
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Fax |
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Provider Business Mailing Address
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Address Line | 3060 W OLYMPIC BLVD APT 434
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City | LOS ANGELES
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State | CA
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Zip | 90006-3838
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Country | US
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Telephone | 213-284-5865
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 111979
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License Number State | CA
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