MEDICARE: JULIA YUNHA JEONG 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	111422	CA
2	1223E0200X	Endodontics	111422	CA

General Provider Information

NPI Number	:	1699561738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA YUNHA JEONG DMD

Provider Business Mailing Address
First Line	:	4850 HOLLYWOOD BLVD APT 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-3264
Country	:	US
Telephone Number	:	607-882-0983
Fax Number	:

Provider Business Practice Location Address
First Line	:	28212 KELLY JOHNSON PKWY STE 290
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91355-5093
Country	:	US
Telephone Number	:	661-254-1924
Fax Number	:

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

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	07/03/2025

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