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General NPI Number Information
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NPI Number | 1689711822
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Entity Type | Individual
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Provider Name | DAVID JAEKWAN JO D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3120 S HACIENDA BLVD SUITE 205
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-6305
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Country | US
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Telephone | 626-330-3116
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Fax | 626-333-5607
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Provider Business Mailing Address
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Address Line | 21655 STONEHAVEN DR
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City | YORBA LINDA
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State | CA
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Zip | 92887-2631
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Country | US
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Telephone | 714-779-1650
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30682
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License Number State | CA
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