Provider Demographics
NPI:1992078737
Name:YOO, KYUNGSUK (DMD)
Entity type:Individual
Prefix:DR
First Name:KYUNGSUK
Middle Name:
Last Name:YOO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 TOWN GREEN DR
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-2325
Mailing Address - Country:US
Mailing Address - Phone:617-599-6317
Mailing Address - Fax:
Practice Address - Street 1:108 TOWN GREEN DR
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-2325
Practice Address - Country:US
Practice Address - Phone:617-599-6317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028460970001Medicaid