Healthcare Provider Details

I. General information

NPI: 1326724576
Provider Name (Legal Business Name): YUJIN C HAMILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

12666 MILLENNIUM
PLAYA VISTA CA
90094-2878
US

V. Phone/Fax

Practice location:
  • Phone: 781-738-3775
  • Fax:
Mailing address:
  • Phone: 781-738-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: