Craig Jeong, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

63595 Issued in CA

Practice address

1075 Via Verde
San Dimas, CA 91773-4347

Phone

(909) 599-8331

NPI assigned

Aug 31, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bennett Jeong, DDS, Inc.

  • Dental Clinic/Center
  • San Dimas, CA
  • NPI 1366850778
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440979200000",
    "number": "1639546112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 VIA VERDE",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917734347",
            "telephone_number": "909-599-8331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 VIA VERDE",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917734347",
            "telephone_number": "909-599-8331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEONG",
        "first_name": "CRAIG",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-08-31",
        "last_updated": "2015-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "63595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashlie Renee Javier
• Lyndsie Von Javier, DPT
• Robert A Jennings, LMFT
• Yuliya Jensen
• Bennett C. Jeong, DDS
• Ryan Jilbert
• Jacqueline Jimenez
• Cathleen Croft Johnson, OTR/L
• Cierra Elaine Johnson
• Nicholette Dawn Johnson

• Dentist in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.