MEDICARE: KYU MEE YO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	28325	TX

General Provider Information

NPI Number	:	1164773420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYU MEE YO DMD

Provider Business Mailing Address
First Line	:	26112 OVERLOOK PKWY
Second Line	:	SUITE 1108
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-6051
Country	:	US
Telephone Number	:	210-293-0809
Fax Number	:	210-520-3424

Provider Business Practice Location Address
First Line	:	26112 OVERLOOK PKWY
Second Line	:	SUITE 1108
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-6051
Country	:	US
Telephone Number	:	210-293-0809
Fax Number	:	210-520-3424

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	09/27/2012

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