Provider Demographics
NPI:1063623825
Name:PYUN, JACLYN HYEJIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:HYEJIN
Last Name:PYUN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:HYE
Other - Middle Name:
Other - Last Name:PYUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4542-A BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621
Mailing Address - Country:US
Mailing Address - Phone:714-670-2875
Mailing Address - Fax:714-670-8463
Practice Address - Street 1:4542-A BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621
Practice Address - Country:US
Practice Address - Phone:714-670-2875
Practice Address - Fax:714-670-8463
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice