Provider Demographics
NPI:1609117043
Name:HUH, YOO KYEOM (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:YOO KYEOM
Middle Name:
Last Name:HUH
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S MARENGO AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4733
Mailing Address - Country:US
Mailing Address - Phone:216-288-8459
Mailing Address - Fax:
Practice Address - Street 1:777 S MARENGO AVE APT 3
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-4733
Practice Address - Country:US
Practice Address - Phone:216-368-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1038441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics