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General NPI Number Information
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NPI Number | 1972024487
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Entity Type | Individual
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Provider Name | JAE HOON PI
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Gender | Male
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 9900 W PARMER LN
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City | AUSTIN
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State | TX
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Zip | 78717-4909
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Country | US
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Telephone | 512-593-2636
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Fax |
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Provider Business Mailing Address
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Address Line | 15824 GARRISON CIR
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City | AUSTIN
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State | TX
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Zip | 78717-3005
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Country | US
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Telephone |
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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 | 101506
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 33945
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License Number State | TX
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