Healthcare Provider Details

I. General information

NPI: 1639518673
Provider Name (Legal Business Name): JONATHAN YOON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 LANDMARK PARKWAY DR STE 201
SAINT LOUIS MO
63127
US

IV. Provider business mailing address

9701 LANDMARK PARKWAY DR STE 201
SAINT LOUIS MO
63127-1665
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-3828
  • Fax: 314-843-3052
Mailing address:
  • Phone: 314-729-0077
  • Fax: 314-729-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number7006
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2018007938
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: