1194335760 NPI number — CHO JEON YUN DENTAL PARTNERSHIP

Table of content: DR. ABDUL-WAHAB HUSSEIN SHARARAH PHARM.D., M.D. (NPI 1912393315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194335760 NPI number — CHO JEON YUN DENTAL PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHO JEON YUN DENTAL PARTNERSHIP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1194335760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
646 N DIAMOND BAR BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIAMOND BAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-845-5088
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9655 MONTE VISTA AVE #406
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-626-8214
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2020

Additional Information

Authorized Official

Authorized Official Last Name:
JEON
Authorized Official First Name:
HYEJIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
269-845-5088

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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