Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 34850 | TX |
NPI | 1023515723 |
---|---|
Provider Name | Kwan Ho Yun |
First Address | Queen Creek, AZ 85142-6875 |
Second Address | Dallas, TX 75246-2013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2018 |
Last Update Date | 26/06/2020 |