Provider Demographics
NPI:1104801604
Name:HUR, KALVIN YONGCHUN (DDS)
Entity type:Individual
Prefix:DR
First Name:KALVIN
Middle Name:YONGCHUN
Last Name:HUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-615 KUPUOHI ST
Mailing Address - Street 2:#206
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797
Mailing Address - Country:US
Mailing Address - Phone:808-688-2888
Mailing Address - Fax:808-688-2345
Practice Address - Street 1:94-615 KUPUOHI ST
Practice Address - Street 2:#206
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-688-2888
Practice Address - Fax:808-688-2345
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0513541223G0001X
HIDT 22741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice