Provider Demographics
NPI:1649582461
Name:YOO, JEE RYANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEE
Middle Name:RYANG
Last Name:YOO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 JADE AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2048
Mailing Address - Country:US
Mailing Address - Phone:310-990-3293
Mailing Address - Fax:
Practice Address - Street 1:12000 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4302
Practice Address - Country:US
Practice Address - Phone:310-990-3293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS2-1881223S0112X, 1223S0112X
CA613351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery