Provider Demographics
NPI:1215178900
Name:KOO, BON HYUN (DDS)
Entity Type:Individual
Prefix:
First Name:BON HYUN
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 1:1693 LIBERTY CT
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-6708
Mailing Address - Country:US
Mailing Address - Phone:925-337-9388
Mailing Address - Fax:
Practice Address - Street 1:1693 LIBERTY CT
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-6708
Practice Address - Country:US
Practice Address - Phone:925-337-9388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist