Provider Demographics
NPI:1588759880
Name:YI, ANN EUN BOK (DDS)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:EUN BOK
Last Name:YI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:EUN BOK
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1401 JUPITER RD
Mailing Address - Street 2:#103
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074
Mailing Address - Country:US
Mailing Address - Phone:469-241-0350
Mailing Address - Fax:469-241-0520
Practice Address - Street 1:1401 JUPITER RD
Practice Address - Street 2:#103
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074
Practice Address - Country:US
Practice Address - Phone:469-241-0350
Practice Address - Fax:469-241-0520
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB19476-01OtherDELTA DENTAL TEXAS CHIP