Provider Demographics
NPI:1629814967
Name:HO, JUN HAE BRIAN (DMD)
Entity type:Individual
Prefix:
First Name:JUN HAE BRIAN
Middle Name:
Last Name:HO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 ALAMEDA BLVD NE UNIT 4139
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2639
Mailing Address - Country:US
Mailing Address - Phone:778-893-3828
Mailing Address - Fax:
Practice Address - Street 1:MSC06 3500 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-925-4031
Practice Address - Fax:505-925-4030
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program