Healthcare Provider Details

I. General information

NPI: 1134477458
Provider Name (Legal Business Name): SEUNG JOON HYUN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KEVIN SEUNG HYUN

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11899 DEL AMO BLVD
CERRITOS CA
90703
US

IV. Provider business mailing address

11899 DEL AMO BLVD
CERRITOS CA
90703-7605
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-4411
  • Fax: 562-606-0119
Mailing address:
  • Phone: 562-402-4411
  • Fax: 562-606-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number61659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: