Provider Demographics
NPI:1023360492
Name:JI WON JUNG, DDS, PC
Entity type:Organization
Organization Name:JI WON JUNG, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JI WON
Authorized Official - Middle Name:J
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-334-8779
Mailing Address - Street 1:2861 W. 120TH AVE
Mailing Address - Street 2:STE 230
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234
Mailing Address - Country:US
Mailing Address - Phone:720-334-8779
Mailing Address - Fax:720-863-6863
Practice Address - Street 1:2861 W. 120TH AVE
Practice Address - Street 2:STE 230
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234
Practice Address - Country:US
Practice Address - Phone:720-334-8779
Practice Address - Fax:720-863-6863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10126261QD0000X
1223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty