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General NPI Number Information
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NPI Number | 1699157602
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Entity Type | Individual
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Provider Name | JONATHAN MATTHEW HURNG D.D.S
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Gender | Male
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 1807 BAY RD
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City | EAST PALO ALTO
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State | CA
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Zip | 94303-1312
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Country | US
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Telephone | 650-289-7700
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Fax | 650-853-1018
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Provider Business Mailing Address
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Address Line | 10550 S FOOTHILL BLVD
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City | CUPERTINO
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State | CA
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Zip | 95014-3914
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Country | US
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Telephone | 408-688-7711
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | DL12597
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11688
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 103677
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License Number State | CA
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