Provider Demographics
NPI:1285797951
Name:JUNG, EUN SUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:EUN
Middle Name:SUNG
Last Name:JUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11832 ROSECRANS AVE
Mailing Address - Street 2:STE. 1409
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4107
Mailing Address - Country:US
Mailing Address - Phone:562-868-6202
Mailing Address - Fax:562-868-6115
Practice Address - Street 1:11832 ROSECRANS AVE
Practice Address - Street 2:STE. 1409
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4107
Practice Address - Country:US
Practice Address - Phone:562-868-6202
Practice Address - Fax:562-868-6115
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD44193OtherMEDI-CAL