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General NPI Number Information
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NPI Number | 1558835165
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Entity Type | Organization
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Legal Business Name | JEON CHO DENTAL PARTNERSHIP
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Dates
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Enumeration Date | 01/16/2019
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 646 N DIAMOND BAR BLVD
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City | DIAMOND BAR
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State | CA
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Zip | 91765
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Country | US
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Telephone | 909-861-2661
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Fax | 909-861-6951
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Provider Business Mailing Address
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Address Line | 646 N DIAMOND BAR BLVD
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City | DIAMOND BAR
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State | CA
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Zip | 91765
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Country | US
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Telephone | 909-861-2661
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Fax | 909-861-6951
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Authorized Official
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Title or Position | MANAGING PARTNER/OWNER
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Name | HYEJIN JEON
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Credential | DDS
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Telephone | 269-845-5088
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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 |
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License Number State |
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