Healthcare Provider Details

I. General information

NPI: 1407384738
Provider Name (Legal Business Name): JI HYUN TAHK DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 07/21/2022
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 HIGH ST
WESTWOOD MA
02090-2535
US

IV. Provider business mailing address

745 HIGH ST
WESTWOOD MA
02090-2535
US

V. Phone/Fax

Practice location:
  • Phone: 781-471-5060
  • Fax:
Mailing address:
  • Phone: 781-318-3886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN1858937
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: