MEDICARE: DR. JOAN YAP JERNIGAN 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	122300000X	Dentist	44192	CA

General Provider Information

NPI Number	:	1629160023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAN YAP JERNIGAN DMD

Provider Business Mailing Address
First Line	:	1939 PACIFIC AVENUE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/08/2007

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