Provider Demographics
NPI:1740514439
Name:HUR, JAE LYUNG (DMD)
Entity type:Individual
Prefix:
First Name:JAE LYUNG
Middle Name:
Last Name:HUR
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 1:7632 S 126TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-4835
Mailing Address - Country:US
Mailing Address - Phone:206-772-5673
Mailing Address - Fax:206-772-5674
Practice Address - Street 1:7632 S 126TH ST.
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98178
Practice Address - Country:US
Practice Address - Phone:206-772-5673
Practice Address - Fax:206-772-5674
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60058466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist