Provider Demographics
NPI:1487875464
Name:HYUN, DEREK D (DDS)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:D
Last Name:HYUN
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 1:13025 POMERADO ROAD
Mailing Address - Street 2:SUITE #B
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4248
Mailing Address - Country:US
Mailing Address - Phone:858-679-2838
Mailing Address - Fax:858-679-2837
Practice Address - Street 1:13025 POMERADO ROAD
Practice Address - Street 2:SUITE #B
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4248
Practice Address - Country:US
Practice Address - Phone:858-679-2838
Practice Address - Fax:858-679-2837
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA409491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice