Healthcare Provider Details

I. General information

NPI: 1255427522
Provider Name (Legal Business Name): JONG UK YOOK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 FLOYD AVE STE 609
MODESTO CA
95355-9802
US

IV. Provider business mailing address

3020 FLOYD AVE STE 609
MODESTO CA
95355-9802
US

V. Phone/Fax

Practice location:
  • Phone: 209-551-1414
  • Fax: 209-551-1033
Mailing address:
  • Phone: 209-551-1414
  • Fax: 209-551-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number49434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: