Provider Demographics
NPI:1396897708
Name:JOH, SHUNG HYUN (D,D,S,)
Entity type:Individual
Prefix:DR
First Name:SHUNG HYUN
Middle Name:
Last Name:JOH
Suffix:
Gender:M
Credentials:D,D,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4533 W RAVINA LN
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1430
Mailing Address - Country:US
Mailing Address - Phone:623-518-2108
Mailing Address - Fax:
Practice Address - Street 1:13651 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1267
Practice Address - Country:US
Practice Address - Phone:602-504-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist