Provider Demographics
NPI:1295812287
Name:TAK, WON HEE (DDS)
Entity type:Individual
Prefix:DR
First Name:WON HEE
Middle Name:
Last Name:TAK
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 1:2 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-3106
Mailing Address - Country:US
Mailing Address - Phone:973-731-2991
Mailing Address - Fax:
Practice Address - Street 1:21015 NORTHERN BLVD STE B
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3239
Practice Address - Country:US
Practice Address - Phone:718-225-0919
Practice Address - Fax:718-225-8005
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022375001223G0001X
NY0480441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice