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General NPI Number Information
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NPI Number | 1952612988
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Entity Type | Individual
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Provider Name | MARY JUNGHYUN UM D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/24/2010
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 6700 S FLORES ST STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78221-1700
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Country | US
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Telephone | 210-460-7811
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Fax |
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Provider Business Mailing Address
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Address Line | 6700 S FLORES ST STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78221-1700
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Country | US
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Telephone | 210-460-7811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 107104
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D-4305
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 35033
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 107104
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License Number State | CA
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