Provider Demographics
NPI:1912281700
Name:MUN, HYO JIN (DDS)
Entity Type:Individual
Prefix:
First Name:HYO
Middle Name:JIN
Last Name:MUN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16229 S WESTERN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4660
Mailing Address - Country:US
Mailing Address - Phone:310-756-6606
Mailing Address - Fax:
Practice Address - Street 1:16229 S WESTERN AVE STE 2
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4660
Practice Address - Country:US
Practice Address - Phone:310-756-6606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA609171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice