Provider Demographics
NPI:1891212866
Name:KEUSUNG YUN DENTAL P.C.
Entity Type:Organization
Organization Name:KEUSUNG YUN DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEUSUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:YUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-710-5526
Mailing Address - Street 1:31 BOGEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:VA
Mailing Address - Zip Code:22844-9667
Mailing Address - Country:US
Mailing Address - Phone:918-710-5526
Mailing Address - Fax:
Practice Address - Street 1:2262 BLUE STONE HILLS DR STE A
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-5434
Practice Address - Country:US
Practice Address - Phone:540-433-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415373261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental