Healthcare Provider Details

I. General information

NPI: 1164573424
Provider Name (Legal Business Name): ANTHONY SUNGJIN YOUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W BIG BEAVER RD SUITE 1200
TROY MI
48084-4900
US

IV. Provider business mailing address

755 W BIG BEAVER RD SUITE 1200
TROY MI
48084-4900
US

V. Phone/Fax

Practice location:
  • Phone: 248-273-7700
  • Fax: 248-273-7701
Mailing address:
  • Phone: 248-273-7700
  • Fax: 248-273-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number4301071818
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA82940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: