Provider Demographics
NPI:1124519103
Name:YOU, HYUN JIN
Entity type:Individual
Prefix:
First Name:HYUN
Middle Name:JIN
Last Name:YOU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9597 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2424
Mailing Address - Country:US
Mailing Address - Phone:833-900-1050
Mailing Address - Fax:909-621-3125
Practice Address - Street 1:1242 STATE AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3672
Practice Address - Country:US
Practice Address - Phone:833-900-1050
Practice Address - Fax:909-621-3125
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60833142122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADN60833142OtherWASHINGTON STATE DEPARTMENT OF HEALTH