Provider Demographics
NPI:1194981837
Name:JUNG, GRACE SEUNG-AH (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:SEUNG-AH
Last Name:JUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15130 DICKENS ST
Mailing Address - Street 2:#208
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5328
Mailing Address - Country:US
Mailing Address - Phone:310-892-5543
Mailing Address - Fax:
Practice Address - Street 1:44244 DIVISION ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-3525
Practice Address - Country:US
Practice Address - Phone:661-942-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA567471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry