Healthcare Provider Details

I. General information

NPI: 1831352418
Provider Name (Legal Business Name): JESSICA YOON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1067 S HOVER ST STE E
LONGMONT CO
80501-7903
US

IV. Provider business mailing address

1067 S HOVER ST STE E
LONGMONT CO
80501-7903
US

V. Phone/Fax

Practice location:
  • Phone: 720-464-1011
  • Fax:
Mailing address:
  • Phone: 720-464-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD171107
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberDR.0060211
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD2017-0862
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC156843
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME108361
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: