Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 63784 | CA |
NPI | 1245687706 |
---|---|
Provider Name | Dr. Wonil Edward Jung |
First Address | Sherman Oaks, CA 91423-2717 |
Second Address | Sherman Oaks, CA 91423-2717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2016 |
Last Update Date | 04/08/2016 |