Provider Demographics
NPI:1538753835
Name:JO, HYANGSEONG
Entity type:Individual
Prefix:
First Name:HYANGSEONG
Middle Name:
Last Name:JO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SOPHIE
Other - Middle Name:
Other - Last Name:JO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:211 W 56TH STREET
Mailing Address - Street 2:APT 7C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:347-510-6885
Mailing Address - Fax:
Practice Address - Street 1:252 MADISON AVE STE 106
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4314
Practice Address - Country:US
Practice Address - Phone:732-997-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062905122300000X
FLDN26633122300000X
390200000X
NJ22DI02881100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program