Provider Demographics
NPI:1295802585
Name:YOO, KAY KYUNGHWA (DDS)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:KYUNGHWA
Last Name:YOO
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 1:2707 S DIAMOND BAR BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3500
Mailing Address - Country:US
Mailing Address - Phone:909-598-7225
Mailing Address - Fax:909-598-2095
Practice Address - Street 1:2707 S DIAMOND BAR BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3500
Practice Address - Country:US
Practice Address - Phone:909-598-7225
Practice Address - Fax:909-598-2095
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB43673-01OtherDELTA HEALTHY FAMILY
CAG93277-01Medicaid