Provider Demographics
NPI:1255427522
Name:YOOK, JONG UK (DDS)
Entity type:Individual
Prefix:
First Name:JONG
Middle Name:UK
Last Name:YOOK
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 1:3020 FLOYD AVE STE 609
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-9802
Mailing Address - Country:US
Mailing Address - Phone:209-551-1414
Mailing Address - Fax:209-551-1033
Practice Address - Street 1:3020 FLOYD AVE STE 609
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-9802
Practice Address - Country:US
Practice Address - Phone:209-551-1414
Practice Address - Fax:209-551-1033
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist