Provider Demographics
NPI:1417053554
Name:GOHARD, YUSUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:YUSUN
Middle Name:
Last Name:GOHARD
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 1:34 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2640
Mailing Address - Country:US
Mailing Address - Phone:973-377-2222
Mailing Address - Fax:201-653-3581
Practice Address - Street 1:34 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2640
Practice Address - Country:US
Practice Address - Phone:973-377-2222
Practice Address - Fax:201-653-3581
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1022553001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice