Provider Demographics
NPI:1861614026
Name:JOO, HANS ROY (DMD)
Entity type:Individual
Prefix:
First Name:HANS
Middle Name:ROY
Last Name:JOO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 S BENTLEY AVE
Mailing Address - Street 2:#201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3587
Mailing Address - Country:US
Mailing Address - Phone:310-871-1355
Mailing Address - Fax:
Practice Address - Street 1:1633 S BENTLEY AVE
Practice Address - Street 2:#201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3587
Practice Address - Country:US
Practice Address - Phone:310-871-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist