Provider Demographics
NPI:1518534239
Name:BYEON, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BYEON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 VENICE BLVD APT 113
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3928
Mailing Address - Country:US
Mailing Address - Phone:323-250-6388
Mailing Address - Fax:
Practice Address - Street 1:55 OLD GATE LN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3612
Practice Address - Country:US
Practice Address - Phone:203-878-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14054122300000X
CA107586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist