Provider Demographics
NPI:1306463294
Name:YOO, HAEYOUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:HAEYOUNG
Middle Name:
Last Name:YOO
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 1:750 N SHORELINE BLVD APT 151
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-3249
Mailing Address - Country:US
Mailing Address - Phone:650-388-8960
Mailing Address - Fax:
Practice Address - Street 1:100 W EL CAMINO REAL STE 63A
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2649
Practice Address - Country:US
Practice Address - Phone:650-563-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1045221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice