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General NPI Number Information
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NPI Number | 1780030304
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Entity Type | Organization
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Legal Business Name | BOM SEOK JEON, DDS, INC
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Dates
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Enumeration Date | 05/12/2016
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 1401 S BROOKHURST RD STE 104
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City | FULLERTON
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State | CA
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Zip | 92833-4492
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Country | US
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Telephone | 714-879-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 S BROOKHURST RD STE 104
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City | FULLERTON
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State | CA
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Zip | 92833-4492
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Country | US
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Telephone | 714-879-2828
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BOM SEOK JEON
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Credential | DDS
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Telephone | 213-700-5090
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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 | 62451
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License Number State | CA
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