Healthcare Provider Details

I. General information

NPI: 1740514439
Provider Name (Legal Business Name): JAE LYUNG HUR D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 10/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7632 S 126TH ST.
SEATTLE WA
98178
US

IV. Provider business mailing address

7632 S 126TH ST
SEATTLE WA
98178-4835
US

V. Phone/Fax

Practice location:
  • Phone: 206-772-5673
  • Fax: 206-772-5674
Mailing address:
  • Phone: 206-772-5673
  • Fax: 206-772-5674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60058466
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: