Provider Demographics
NPI:1376776286
Name:JANG, SUK YEUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUK
Middle Name:YEUL
Last Name:JANG
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 1:202 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-1210
Mailing Address - Country:US
Mailing Address - Phone:914-241-0283
Mailing Address - Fax:914-241-0573
Practice Address - Street 1:202 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-1210
Practice Address - Country:US
Practice Address - Phone:914-241-0283
Practice Address - Fax:914-241-0573
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY372711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice