Provider Demographics
NPI:1871613372
Name:KYUNG, EUN S (DDS)
Entity type:Individual
Prefix:DR
First Name:EUN
Middle Name:S
Last Name:KYUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 N PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-1619
Mailing Address - Country:US
Mailing Address - Phone:818-550-0830
Mailing Address - Fax:818-550-9130
Practice Address - Street 1:1219 N PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-1619
Practice Address - Country:US
Practice Address - Phone:818-550-0830
Practice Address - Fax:818-550-9130
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice