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General NPI Number Information
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NPI Number | 1861848079
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Entity Type | Organization
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Legal Business Name | HI DENTAL, PLLC
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 154 S FRONT ST
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City | FARMINGDALE
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State | NY
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Zip | 11735-2637
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Country | US
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Telephone | 516-586-8877
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Fax | 516-586-8878
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Provider Business Mailing Address
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Address Line | 154 S FRONT ST
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City | FARMINGDALE
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State | NY
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Zip | 11735-2637
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Country | US
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Telephone | 516-586-8877
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Fax | 516-586-8878
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Authorized Official
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Title or Position | OWNER
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Name | DR. HYESUNG IM
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Credential | DDS
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Telephone | 516-586-8877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0539151
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License Number State | NY
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