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General NPI Number Information
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NPI Number | 1659792927
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Entity Type | Individual
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Provider Name | SONG WOO JUNG DDS
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Gender | Male
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 434 S EUCLID ST # 100
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City | ANAHEIM
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State | CA
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Zip | 92802-1247
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Country | US
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Telephone | 714-533-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 24642 VESTA
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City | MISSION VIEJO
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State | CA
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Zip | 92691-4718
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Country | US
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Telephone | 312-533-6386
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 63185
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License Number State | CA
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