Provider Demographics
NPI:1124258736
Name:CHI, HYUNSEOK CHARLIE (DDS, DMD)
Entity type:Individual
Prefix:DR
First Name:HYUNSEOK
Middle Name:CHARLIE
Last Name:CHI
Suffix:
Gender:M
Credentials:DDS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 ELLINGTON PARK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-6049
Mailing Address - Country:US
Mailing Address - Phone:702-589-6293
Mailing Address - Fax:
Practice Address - Street 1:640 E DEER SPRINGS WAY STE 180
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086
Practice Address - Country:US
Practice Address - Phone:702-399-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29610122300000X
CA57861122300000X
FLDN18605122300000X
NV69021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist