Provider Demographics
NPI:1447599162
Name:FULLER, HYE YONG (RDH)
Entity type:Individual
Prefix:MRS
First Name:HYE
Middle Name:YONG
Last Name:FULLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595TH MAINTENANCE COMPANY K-16 BOX989
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96202
Mailing Address - Country:US
Mailing Address - Phone:0102-560-5505
Mailing Address - Fax:
Practice Address - Street 1:595TH MAINTENANCE COMPANY K-16 BOX989
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96202
Practice Address - Country:US
Practice Address - Phone:0102-560-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8163124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist