Provider Demographics
NPI:1144223132
Name:YI, PAUL SANGTAEK (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:SANGTAEK
Last Name:YI
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 1:516 N ROLLING RD
Mailing Address - Street 2:STE 102
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4141
Mailing Address - Country:US
Mailing Address - Phone:410-744-3446
Mailing Address - Fax:410-744-3685
Practice Address - Street 1:516 N ROLLING RD
Practice Address - Street 2:STE 102
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4141
Practice Address - Country:US
Practice Address - Phone:410-744-3446
Practice Address - Fax:410-744-3685
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD093411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice