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General NPI Number Information
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NPI Number | 1811319080
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Entity Type | Organization
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Legal Business Name | JINYONG CHUN DDS INC
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 07/01/2014
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Provider Practice Location Address
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Address Line | 7255 JOSHUA LN STE B
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-2948
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Country | US
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Telephone | 760-365-8331
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Fax | 760-228-5870
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Provider Business Mailing Address
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Address Line | 7255 JOSHUA LN STE B
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-2948
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Country | US
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Telephone | 760-365-8331
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Fax | 760-228-5870
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Authorized Official
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Title or Position | C.E.O
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Name | JIN YONG CHUN
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Credential | D.D.S
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Telephone | 909-472-5810
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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 | 61416
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License Number State | CA
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