Provider Demographics
NPI:1457767618
Name:JO, YOUNG SIL
Entity type:Individual
Prefix:
First Name:YOUNG SIL
Middle Name:
Last Name:JO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 LOS INDIOS PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7584
Mailing Address - Country:US
Mailing Address - Phone:718-309-1121
Mailing Address - Fax:956-843-0179
Practice Address - Street 1:3300 N MCCOLL RD STE M
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-843-0177
Practice Address - Fax:956-843-0179
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD41421223G0001X
TX320611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice