Provider Demographics
NPI:1053154450
Name:YOO, ANGELA HANA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:HANA
Last Name:YOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 E INTERSTATE 30 STE 107
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4912
Mailing Address - Country:US
Mailing Address - Phone:972-722-4914
Mailing Address - Fax:
Practice Address - Street 1:1039 E INTERSTATE 30 STE 107
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4912
Practice Address - Country:US
Practice Address - Phone:972-722-4914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61556984122300000X
TX41325122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist