Provider Demographics
NPI:1992828446
Name:YU, KYUNG SOOK (DDS)
Entity Type:Individual
Prefix:MS
First Name:KYUNG
Middle Name:SOOK
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 1:1370 S BEACH BLVD
Mailing Address - Street 2:#E
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-1178
Mailing Address - Country:US
Mailing Address - Phone:562-694-5850
Mailing Address - Fax:562-694-5838
Practice Address - Street 1:1370 S BEACH BLVD
Practice Address - Street 2:#E
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-1178
Practice Address - Country:US
Practice Address - Phone:562-694-5850
Practice Address - Fax:562-694-5838
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice