Provider Demographics
NPI:1114754314
Name:MEDIPRODENTAL INC
Entity type:Organization
Organization Name:MEDIPRODENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOOSUK
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:929-340-9390
Mailing Address - Street 1:752 SIGMUND RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1338
Mailing Address - Country:US
Mailing Address - Phone:929-340-9390
Mailing Address - Fax:
Practice Address - Street 1:109 N MILWAUKEE AVE FL 2
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3013
Practice Address - Country:US
Practice Address - Phone:929-340-9390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental