MEDICARE: JOAN YAP JERNIGAN DENTAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	44192	CA

General Provider Information

NPI Number	:	1194923573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOAN YAP JERNIGAN DENTAL CORP

Provider Business Mailing Address
First Line	:	1939 PACIFIC AVENUE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-5321
Country	:	US
Telephone Number	:	562-591-1331
Fax Number	:	562-591-1332

Provider Business Practice Location Address
First Line	:	1939 PACIFIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-5321
Country	:	US
Telephone Number	:	562-591-1331
Fax Number	:	562-591-1332

Authorized Official
Title or Position	:	CEO
Name	:	DR. JOAN YAP JERNIGAN
Credential	:	DMD
Telephone Number	:	562-591-1331

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	08/22/2020

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