MEDICARE: DR. JUNG HUN JI D.D.S.

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	64039	CA
2	122300000X	Dentist	6580	NV
3	122300000X	Dentist	D10382	OR

General Provider Information

NPI Number	:	1477957850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUNG HUN JI D.D.S.

Provider Business Mailing Address
First Line	:	19731 S HIGHWAY 213
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4190
Country	:	US
Telephone Number	:	503-518-3384
Fax Number	:	503-518-3385

Provider Business Practice Location Address
First Line	:	19731 S HIGHWAY 213
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4190
Country	:	US
Telephone Number	:	503-518-3384
Fax Number	:	503-518-3385

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

Provider Enumeration Date	:	10/14/2014
Last Update Date	:	09/12/2018

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