Healthcare Provider Details

I. General information

NPI: 1639767155
Provider Name (Legal Business Name): JUN HYUK HUH DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2021
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 WEST 168TH STREET VC7 OMFS CLINIC
NEW YORK NY
10032
US

IV. Provider business mailing address

630 WEST 168TH ST. VC7 OMFS CLINIC
NEW YORK NY
10032
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5690
  • Fax:
Mailing address:
  • Phone: 212-305-5690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number105161
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: