Provider Demographics
NPI:1538417795
Name:LYU, JEE HYUN (DDS)
Entity type:Individual
Prefix:
First Name:JEE HYUN
Middle Name:
Last Name:LYU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:LYU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13875 HWY 13, FRONTAGE RD
Mailing Address - Street 2:SUITE 50
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378
Mailing Address - Country:US
Mailing Address - Phone:952-226-7940
Mailing Address - Fax:
Practice Address - Street 1:13875 HWY 13, FRONTAGE RD
Practice Address - Street 2:SUITE 50
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378
Practice Address - Country:US
Practice Address - Phone:952-226-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.3257122300000X
MNR5701223S0112X
MND138921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist