Provider Demographics
NPI:1639231624
Name:YEUP, JENNY (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:MISS
First Name:JENNY
Middle Name:
Last Name:YEUP
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 41ST AVE APT 511
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2415
Mailing Address - Country:US
Mailing Address - Phone:718-358-8646
Mailing Address - Fax:
Practice Address - Street 1:3411 VERNON BLVD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-5121
Practice Address - Country:US
Practice Address - Phone:718-726-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023890124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist