MEDICARE: JESSICA M PYUN DMD

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	1223G0001X	General Practice Dentistry	63880	CA

General Provider Information

NPI Number	:	1396148334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA M PYUN DMD

Provider Business Mailing Address
First Line	:	914 LINCOLN BLVD
Second Line	:	APT 108
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-2856
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 BALDWIN PARK BLVD STE D100
Second Line	:
City	:	BALDWIN PARK
State	:	CA
Zip	:	91706-4704
Country	:	US
Telephone Number	:	626-813-4488
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2014
Last Update Date	:	10/06/2014

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