Provider Demographics
NPI:1205357290
Name:JEONG, CHRISTINA DAHEE (DE60762062)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DAHEE
Last Name:JEONG
Suffix:
Gender:F
Credentials:DE60762062
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 SW 330TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-6432
Mailing Address - Country:US
Mailing Address - Phone:253-332-8055
Mailing Address - Fax:
Practice Address - Street 1:33505 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6809
Practice Address - Country:US
Practice Address - Phone:253-815-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60762062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist