Provider Demographics
NPI:1972777399
Name:SON, HYEOKJIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:HYEOKJIN
Middle Name:
Last Name:SON
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 1:200 N CASS ST
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1161
Mailing Address - Country:US
Mailing Address - Phone:269-471-7970
Mailing Address - Fax:269-471-9508
Practice Address - Street 1:1111 LAMBERT ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-3439
Practice Address - Country:US
Practice Address - Phone:269-262-4689
Practice Address - Fax:269-262-4697
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010-190201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice