Active NPI
Dongjun Jeong, D.D.S
- General Practice Dentistry
- Redlands, CA
National Provider Identifier
1871844423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 61931
- Practice address
- 26630 Barton Rd Apt 412
Redlands, CA 92373-4324 - Phone
- (951) 897-4053
- NPI assigned
- Sep 23, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 61931 | CA | Primary |
Addresses
Primary practice location
26630 Barton Rd Apt 412
Redlands, CA 92373-4324
Mailing address
26630 Barton Rd Apt 412
Redlands, CA 92373-4324
Phone (951) 897-4053
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170228000784 | CA | Order and Referring Only - Dentist | 7810271459 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61931 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348358400000",
"number": "1871844423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26630 BARTON RD APT 412",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923734324",
"telephone_number": "951-897-4053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26630 BARTON RD APT 412",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923734324",
"telephone_number": "951-897-4053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEONG",
"first_name": "DONGJUN",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-23",
"last_updated": "2012-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "61931",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redlands, CA
- Jeffry Wu O.D. Professional Corporation (State Street Optometry)
- Monica Jenkins, MSN, FNP-C
- Jennifer Cobanov, MD Professional Corporation (My Pediatric Home)
- Jennifer Hayhurst Physician Assistant Apc (Radiant Dermatology)
- Michelle Jensen
- Yanghoon Peter Jeong
- Mathew Jerome
- Jessica de la Rosa Licensed Clinical Social Worker, Inc.
- Jesus a Flores D D S
- Jessica Jewett, OTR/L
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2012; 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.