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General NPI Number Information
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NPI Number | 1720485832
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Entity Type | Organization
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Legal Business Name | UKJAE JUNG DDS INCORPORATED
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 12/04/2014
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Provider Practice Location Address
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Address Line | 1227 W 17TH ST
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City | SANTA ANA
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State | CA
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Zip | 92706-3455
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Country | US
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Telephone | 714-881-1441
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Fax | 714-881-1448
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Provider Business Mailing Address
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Address Line | 1227 W 17TH ST
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City | SANTA ANA
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State | CA
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Zip | 92706-3455
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Country | US
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Telephone | 714-881-1441
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Fax | 714-881-1448
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | MICHELLE SANDOVAL
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Credential |
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Telephone | 714-525-6900
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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 | 59393
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License Number State | CA
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