Healthcare Provider Details

I. General information

NPI: 1417178294
Provider Name (Legal Business Name): DAE WOOK HUR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVE WOOK HUR DDS

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 EAST ORANGETHORPE AVE
ANAHEIM CA
92801
US

IV. Provider business mailing address

40 EAST ORANGETHORPE AVE
ANAHEIM CA
92801
US

V. Phone/Fax

Practice location:
  • Phone: 714-870-6611
  • Fax: 714-870-6617
Mailing address:
  • Phone: 714-870-6611
  • Fax: 714-870-6617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number27298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: