Provider Demographics
NPI:1821248758
Name:YU, SEO YEON (DDS)
Entity Type:Individual
Prefix:
First Name:SEO
Middle Name:YEON
Last Name:YU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336B 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-2225
Mailing Address - Country:US
Mailing Address - Phone:917-519-3737
Mailing Address - Fax:
Practice Address - Street 1:153 DYCKMAN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1003
Practice Address - Country:US
Practice Address - Phone:212-569-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053240-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice