Bom Seok Jeon, DDS, Inc

Primary specialty

DentistTaxonomy code 122300000X

License

62451 Issued in CA

Legal business name

BOM SEOK JEON, DDS, INC

Practice address

1401 S Brookhurst Rd Ste 104
Fullerton, CA 92833-4492

Phone

(714) 879-2828

NPI assigned

May 12, 2016

Organization subpart

No

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

Authorized official

Name

Bom Seok Jeon, DDS

Title

President

Phone

(213) 700-5090

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1463011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463011200000",
    "number": "1780030304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S BROOKHURST RD STE 104",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928334492",
            "telephone_number": "714-879-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 S BROOKHURST RD STE 104",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928334492",
            "telephone_number": "714-879-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOM SEOK JEON, DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-12",
        "last_updated": "2016-05-12",
        "status": "A",
        "authorized_official_last_name": "JEON",
        "authorized_official_first_name": "BOM SEOK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-700-5090",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "62451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTICAL",
            "identifier": "1295175859",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawna Bohannon Browne, LCSW
• Lidia Inel Bojorquez
• Lisa Ann Bojorquez
• Richard Charles Bollin Jr., MD
• Bom Jeon Dental Corp
• Bom Vichae Home Health Agency LLC
• Bom Vichae Physical Therapy Professional Corporation
• Frank Anthony Bonavita, MD
• David Michael Boner
• Genille Marie Bonilla-Taylor

• Dentist in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.