Healthcare Provider Details

I. General information

NPI: 1174187298
Provider Name (Legal Business Name): HOPE DENTAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 05/23/2020
Certification Date: 05/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 LONG BEACH BLVD
LYNWOOD CA
90262
US

IV. Provider business mailing address

1820 PALISADES DR.
PACIFIC PALISADES CA
90272
US

V. Phone/Fax

Practice location:
  • Phone: 310-570-9731
  • Fax:
Mailing address:
  • Phone: 310-570-9731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JOO HYEONG YOO
Title or Position: C.E.O.
Credential: D.D.S.
Phone: 310-570-9731