Healthcare Provider Details

I. General information

NPI: 1124374038
Provider Name (Legal Business Name): SOO KYO YOON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2012
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10322 BRISTOW STATION DR STE 109
BRISTOW VA
20136-1435
US

IV. Provider business mailing address

10322 BRISTOW STATION DR STE 109
BRISTOW VA
20136-1435
US

V. Phone/Fax

Practice location:
  • Phone: 703-596-9290
  • Fax:
Mailing address:
  • Phone: 703-596-9290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401416437
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: