Healthcare Provider Details

I. General information

NPI: 1497735377
Provider Name (Legal Business Name): TONY KYUNGSIK YOON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 THOMAS JOHNSON DR SUITE 123
FREDERICK MD
21702-4361
US

IV. Provider business mailing address

70 THOMAS JOHNSON DR SUITE 123
FREDERICK MD
21702-4361
US

V. Phone/Fax

Practice location:
  • Phone: 301-668-3000
  • Fax:
Mailing address:
  • Phone: 301-668-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number15088
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: