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NPI Code Detail

MEDICARE: YOUNGSUK YOUN O.D.

MEDICARE: YOUNGSUK YOUN O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist4901004231MI
2152WC0802XCorneal and Contact Management Optometrist4901004231MI

General Provider Information

NPI Number : 1316918022
Entity Type Code : Individual
Provider Name (Legal Business Name) : YOUNGSUK YOUN O.D.
Provider Business Mailing Address
First Line : 39150 CITATION PL
Second Line : APT 34102
City : FARMINGTON HILLS
State : MI
Zip : 48331-4900
Country : US
Telephone Number : 248-661-4706
Fax Number :
Provider Business Practice Location Address
First Line : 35184 CENTRAL CITY PKWY
Second Line :
City : WESTLAND
State : MI
Zip : 48185-6215
Country : US
Telephone Number : 734-427-5200
Fax Number : 734-427-8136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2006
Last Update Date : 03/11/2014

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