Provider Demographics
NPI:1730104407
Name:DO, YONGSOK (DMD)
Entity Type:Individual
Prefix:DR
First Name:YONGSOK
Middle Name:
Last Name:DO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-2139 FORT WEAVER RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3607
Mailing Address - Country:US
Mailing Address - Phone:808-680-9411
Mailing Address - Fax:808-676-9847
Practice Address - Street 1:91-2139 FORT WEAVER RD
Practice Address - Street 2:SUITE 301
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3607
Practice Address - Country:US
Practice Address - Phone:808-680-9411
Practice Address - Fax:808-676-9847
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0351781223P0221X
HIDT-23161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry