Provider Demographics
NPI:1043428253
Name:KOO, YONG-HAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:YONG-HAN
Middle Name:
Last Name:KOO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 BOSTON POST RD STE 2
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1836
Mailing Address - Country:US
Mailing Address - Phone:508-276-1222
Mailing Address - Fax:
Practice Address - Street 1:241 BOSTON POST RD STE 2
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1836
Practice Address - Country:US
Practice Address - Phone:508-276-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN220581223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery