Provider Demographics
NPI:1275009342
Name:AN, HYOJAE (DDS)
Entity Type:Individual
Prefix:
First Name:HYOJAE
Middle Name:
Last Name:AN
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 1:989 112TH AVE NE APT 607
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4568
Mailing Address - Country:US
Mailing Address - Phone:191-721-4736
Mailing Address - Fax:
Practice Address - Street 1:3602 6TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5450
Practice Address - Country:US
Practice Address - Phone:253-271-9734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE608866661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice