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General NPI Number Information
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NPI Number | 1720378664
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Entity Type | Organization
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Legal Business Name | YONGSOK DO, D.M.D., L.L.C
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 91-2139 FORT WEAVER RD SUITE 301
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City | EWA BEACH
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State | HI
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Zip | 96706-3607
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Country | US
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Telephone | 808-680-9411
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Fax |
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Provider Business Mailing Address
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Address Line | 91-2139 FORT WEAVER RD SUITE 301
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City | EWA BEACH
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State | HI
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Zip | 96706-3607
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Country | US
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Telephone | 808-680-9411
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | YONGSOK DO
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Credential | D.M.D.
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Telephone | 808-680-9411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DT-2316
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License Number State | HI
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