Provider Demographics
NPI:1447590773
Name:KOH, JOON-YONG
Entity Type:Individual
Prefix:
First Name:JOON-YONG
Middle Name:
Last Name:KOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 ULSTER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE KATRINE
Mailing Address - State:NY
Mailing Address - Zip Code:12449-5426
Mailing Address - Country:US
Mailing Address - Phone:845-512-1230
Mailing Address - Fax:
Practice Address - Street 1:1733 ULSTER AVE
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5426
Practice Address - Country:US
Practice Address - Phone:412-818-4975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-23
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059553-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice