1801936968 NPI number — DR. JUNG-WOOK BYUN DDS

Table of content: DR. JUNG-WOOK BYUN DDS (NPI 1801936968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801936968 NPI number — DR. JUNG-WOOK BYUN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYUN
Provider First Name:
JUNG-WOOK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801936968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1053 N STATE COLLEGE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92806-2702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-687-0800
Provider Business Mailing Address Fax Number:
714-687-0880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15731 DOWNEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARAMOUNT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90723-4407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-634-2828
Provider Business Practice Location Address Fax Number:
562-634-2880
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  48707 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G92894 . This is a "DENTI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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