Provider Demographics
NPI:1548664931
Name:JAE K. JUNG DMD, INC.
Entity type:Organization
Organization Name:JAE K. JUNG DMD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:KYUN
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:213-453-2195
Mailing Address - Street 1:2455 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-4341
Mailing Address - Country:US
Mailing Address - Phone:310-320-6789
Mailing Address - Fax:310-320-6790
Practice Address - Street 1:2455 SEPULVEDA BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-4341
Practice Address - Country:US
Practice Address - Phone:310-320-6789
Practice Address - Fax:310-320-6790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA602081223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty