Provider Demographics
NPI:1093849648
Name:HA, KYUNG JOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYUNG
Middle Name:JOO
Last Name:HA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-2155
Mailing Address - Country:US
Mailing Address - Phone:973-762-7009
Mailing Address - Fax:
Practice Address - Street 1:383 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-2155
Practice Address - Country:US
Practice Address - Phone:973-762-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI19174122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist