Provider Demographics
NPI:1558133546
Name:JY DENTAL LLC
Entity Type:Organization
Organization Name:JY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-536-5090
Mailing Address - Street 1:1003 BISHOP ST STE 393
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-6409
Mailing Address - Country:US
Mailing Address - Phone:808-536-5090
Mailing Address - Fax:
Practice Address - Street 1:1003 BISHOP ST STE 393
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6409
Practice Address - Country:US
Practice Address - Phone:808-536-5090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental