Provider Demographics
NPI:1023515723
Name:YUN, KWAN HO (DDS)
Entity type:Individual
Prefix:
First Name:KWAN HO
Middle Name:
Last Name:YUN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:YUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:19144 E RAVEN DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6875
Mailing Address - Country:US
Mailing Address - Phone:480-686-5798
Mailing Address - Fax:
Practice Address - Street 1:5010 LAGUNA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-4148
Practice Address - Country:US
Practice Address - Phone:916-442-7873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX348501223P0221X
CA1052211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry