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General NPI Number Information
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NPI Number | 1861271512
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Entity Type | Individual
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Provider Name | DEBORA JEONG DDS
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Gender | Female
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Dates
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Enumeration Date | 09/22/2023
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 9434 FIRESTONE BLVD
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City | DOWNEY
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State | CA
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Zip | 90241-5504
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Country | US
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Telephone | 562-803-9999
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Fax | 562-803-6369
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Provider Business Mailing Address
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Address Line | 10426 FLORA VISTA ST
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City | BELLFLOWER
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State | CA
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Zip | 90706-5066
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Country | US
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Telephone | 562-445-5936
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 109516
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License Number State | CA
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