Provider Demographics
NPI:1548018443
Name:YOUKHEANG, SOPHIE (DMD)
Entity type:Individual
Prefix:MRS
First Name:SOPHIE
Middle Name:
Last Name:YOUKHEANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 KIAUEA AVE., HILO FAMILY DENTAL CENTER
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-333-3610
Mailing Address - Fax:808-333-3617
Practice Address - Street 1:1257 KIAUEA AVE., HILO FAMILY DENTAL CENTER
Practice Address - Street 2:SUITE 100
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-333-3610
Practice Address - Fax:808-333-3617
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program