Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | A106794 | CA |
NPI | 1114173721 |
---|---|
Provider Name | Dr. Jae Jun |
First Address | Sacramento, CA 95823-4913 |
Second Address | Sacramento, CA 95823-4913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2008 |
Last Update Date | 15/12/2021 |