Provider Demographics
NPI:1346538980
Name:YOO, HYUNCHUL R (DDS)
Entity type:Individual
Prefix:DR
First Name:HYUNCHUL
Middle Name:R
Last Name:YOO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4118
Mailing Address - Country:US
Mailing Address - Phone:516-921-8260
Mailing Address - Fax:516-921-8261
Practice Address - Street 1:240 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4118
Practice Address - Country:US
Practice Address - Phone:516-921-8260
Practice Address - Fax:516-921-8261
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049943122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist