Active NPI
Wonjung Jeong, 1223G0001X
- Dentist
- Los Angeles, CA
National Provider Identifier
1396809240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 49341
- Practice address
- 936 S Alvarado St
Los Angeles, CA 90006-3008 - Phone
- (213) 380-1996
- NPI assigned
- Dec 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 49341 | CA | Primary |
Addresses
Primary practice location
936 S Alvarado St
Los Angeles, CA 90006-3008
Mailing address
8543 Luxor St
Downey, CA 90241-5135
Phone (562) 862-9499
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49341 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197331200000",
"number": "1396809240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8543 LUXOR ST",
"city": "DOWNEY",
"state": "CA",
"postal_code": "902415135",
"telephone_number": "562-862-9499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "936 S ALVARADO ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900063008",
"telephone_number": "213-380-1996"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEONG",
"first_name": "WONJUNG",
"credential": "1223G0001X",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-21",
"last_updated": "2007-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "49341",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.