Provider Demographics
NPI:1306229513
Name:LYU, HAN WOOL (DMD)
Entity Type:Individual
Prefix:
First Name:HAN
Middle Name:WOOL
Last Name:LYU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BRIDGE PLZ N
Mailing Address - Street 2:APT 11C
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5911
Mailing Address - Country:US
Mailing Address - Phone:201-800-1039
Mailing Address - Fax:
Practice Address - Street 1:201 BRIDGE PLZ N
Practice Address - Street 2:APT 11C
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5911
Practice Address - Country:US
Practice Address - Phone:201-800-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02519800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist