Provider Demographics
NPI:1417178294
Name:HUR, DAE WOOK (DDS)
Entity Type:Individual
Prefix:
First Name:DAE
Middle Name:WOOK
Last Name:HUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DAVE
Other - Middle Name:WOOK
Other - Last Name:HUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:40 EAST ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801
Mailing Address - Country:US
Mailing Address - Phone:714-870-6611
Mailing Address - Fax:714-870-6617
Practice Address - Street 1:40 EAST ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-870-6611
Practice Address - Fax:714-870-6617
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2729801OtherMEDI CAL