Provider Demographics
NPI:1740464080
Name:YI, JUHYONG (DDS, MS, PHD)
Entity type:Individual
Prefix:DR
First Name:JUHYONG
Middle Name:
Last Name:YI
Suffix:
Gender:M
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4846 EL CAMINO REAL
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1405
Mailing Address - Country:US
Mailing Address - Phone:650-964-2225
Mailing Address - Fax:650-964-2056
Practice Address - Street 1:4846 EL CAMINO REAL
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1405
Practice Address - Country:US
Practice Address - Phone:650-964-2225
Practice Address - Fax:650-964-2056
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA482061223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics