Provider Demographics
NPI:1568788396
Name:WAYLAND ORAL SURGERY, P.C.
Entity Type:Organization
Organization Name:WAYLAND ORAL SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YONG-HAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-889-8916
Mailing Address - Street 1:241 BOSTON POST RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1836
Mailing Address - Country:US
Mailing Address - Phone:203-889-8916
Mailing Address - Fax:
Practice Address - Street 1:241 BOSTON POST RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1836
Practice Address - Country:US
Practice Address - Phone:203-889-8916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN22058261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery