=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821246513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WON JUNG JEONG,DDS,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2008
-----------------------------------------------------
Last Update Date | 01/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 936 S ALVARADO ST
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90006-3008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-380-1996
-----------------------------------------------------
Fax | 213-382-5737
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9434 FIRESTONE BLVD
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90241-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-803-9999
-----------------------------------------------------
Fax | 562-803-6369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WON JUNG JEONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-380-1996
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 49341
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------