Provider Demographics
NPI:1952612988
Name:UM, MARY JUNGHYUN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JUNGHYUN
Last Name:UM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 S FLORES ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1700
Mailing Address - Country:US
Mailing Address - Phone:210-460-7811
Mailing Address - Fax:
Practice Address - Street 1:6700 S FLORES ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1700
Practice Address - Country:US
Practice Address - Phone:210-460-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1071041223E0200X, 1223S0112X
IDD-43051223G0001X
TX350331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice