Provider Demographics
NPI:1326105925
Name:YUEN, GARY GL (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:GL
Last Name:YUEN
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 1:615 PIIKOI ST STE 1607
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3142
Mailing Address - Country:US
Mailing Address - Phone:808-593-9344
Mailing Address - Fax:808-593-0020
Practice Address - Street 1:615 PIIKOI ST STE 1607
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3142
Practice Address - Country:US
Practice Address - Phone:808-593-9344
Practice Address - Fax:808-593-0020
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice