Provider Demographics
NPI:1073207312
Name:EUNICE JONG DDS INC.
Entity type:Organization
Organization Name:EUNICE JONG DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-999-2215
Mailing Address - Street 1:4073 W LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4879
Mailing Address - Country:US
Mailing Address - Phone:310-999-2215
Mailing Address - Fax:
Practice Address - Street 1:5980 STONERIDGE DR STE 116
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2723
Practice Address - Country:US
Practice Address - Phone:925-462-7212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental