Provider Demographics
NPI:1508843715
Name:HAM, JAE HYON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:HYON
Last Name:HAM
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 1:1040 GARLAND DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622
Mailing Address - Country:US
Mailing Address - Phone:770-725-7377
Mailing Address - Fax:770-725-7176
Practice Address - Street 1:1040 GARLAND DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-3201
Practice Address - Country:US
Practice Address - Phone:770-725-7377
Practice Address - Fax:770-725-7176
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist