Individual
JOONHO PHIYO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3719 JEWELLA AVE, SHREVEPORT, LA 71109-4703
(318) 758-9123
Mailing address
3719 JEWELLA AVE, SHREVEPORT, LA 71109-4703
(318) 758-9123
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7209
LA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
7209
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
LA
Other
Enumeration date
02/08/2021
Last updated
03/13/2026
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