Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DE61022504 | WA |
NPI | 1760860027 |
---|---|
Provider Name | Jennifer Joung |
First Address | Chehalis, WA 98532-2412 |
Second Address | Chehalis, WA 98532-2412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2015 |
Last Update Date | 07/01/2020 |