Provider Demographics
NPI:1699157602
Name:HURNG, JONATHAN MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MATTHEW
Last Name:HURNG
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 1:10550 S FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3914
Mailing Address - Country:US
Mailing Address - Phone:408-688-7711
Mailing Address - Fax:
Practice Address - Street 1:1807 BAY RD
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-1312
Practice Address - Country:US
Practice Address - Phone:650-289-7700
Practice Address - Fax:650-853-1018
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL12597390200000X
CT116881223G0001X
CA1036771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice