Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DE60828989 | WA |
NPI | 1124224019 |
---|---|
Provider Name | Eirleen Young-Ju Hyun |
First Address | Wright Patterson Afb, OH 45433-5529 |
Second Address | Wright Patterson Afb, OH 45433-5529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 03/04/2018 |