Provider Demographics
NPI:1154703890
Name:HUGH, KYUNG LESLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:KYUNG
Middle Name:LESLEY
Last Name:HUGH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1129
Mailing Address - Country:US
Mailing Address - Phone:213-700-5573
Mailing Address - Fax:818-957-4512
Practice Address - Street 1:404 S FIGUEROA ST STE 207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90071-1795
Practice Address - Country:US
Practice Address - Phone:213-700-5573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1007441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice