Provider Demographics
NPI:1689871691
Name:YOO, DANIEL KUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KUN
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 1:449 WAYMARKET DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 ROCK RD STE 101
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1746
Practice Address - Country:US
Practice Address - Phone:201-345-3133
Practice Address - Fax:201-345-3490
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2091019652122300000X
NJ22DI027314001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist