Healthcare Provider Details

I. General information

NPI: 1750342838
Provider Name (Legal Business Name): YOUNG-HO YOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 W CENTRAL ST
NATICK MA
01760
US

IV. Provider business mailing address

171 MAIN ST STE 203B
ASHLAND MA
01721-1187
US

V. Phone/Fax

Practice location:
  • Phone: 508-653-2133
  • Fax: 508-653-4689
Mailing address:
  • Phone: 508-881-3029
  • Fax: 508-881-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number220356
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier110037911A
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: