Healthcare Provider Details

I. General information

NPI: 1891212866
Provider Name (Legal Business Name): KEUSUNG YUN DENTAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2262 BLUE STONE HILLS DR STE A
HARRISONBURG VA
22801-5434
US

IV. Provider business mailing address

31 BOGEY AVE
NEW MARKET VA
22844-9667
US

V. Phone/Fax

Practice location:
  • Phone: 540-433-3080
  • Fax:
Mailing address:
  • Phone: 918-710-5526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number0401415373
License Number StateVA

VIII. Authorized Official

Name: KEUSUNG YUN
Title or Position: CEO
Credential:
Phone: 918-710-5526