Healthcare Provider Details

I. General information

NPI: 1407352099
Provider Name (Legal Business Name): JEE HYE HUH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY JEE HYE HUH DMD

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11092 ANDERSON ST PRINCE HALL 1452
LOMA LINDA CA
92350-4330
US

IV. Provider business mailing address

11092 ANDERSON STREET PRINCE HALL 3301
LOMA LINDA CA
92350-0001
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4689
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number102347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: