Provider Demographics
NPI:1447867163
Name:JUNG, TAEWON TIMOTHY (DDS)
Entity type:Individual
Prefix:
First Name:TAEWON
Middle Name:TIMOTHY
Last Name:JUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:TAI WON
Other - Middle Name:
Other - Last Name:JOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25312 CASSANDRA CT
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3707
Mailing Address - Country:US
Mailing Address - Phone:949-302-1379
Mailing Address - Fax:
Practice Address - Street 1:25312 CASSANDRA CT
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-3707
Practice Address - Country:US
Practice Address - Phone:949-302-1379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS105600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist