Healthcare Provider Details

I. General information

NPI: 1043418783
Provider Name (Legal Business Name): YOON MO MYUNG MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5453 GOVERNOR C PEERY HIGHWAY
RAVEN VA
24639
US

IV. Provider business mailing address

PO BOX 215
DORAN VA
24612-0215
US

V. Phone/Fax

Practice location:
  • Phone: 740-645-7881
  • Fax:
Mailing address:
  • Phone: 740-645-7881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.086322
License Number StateOH

VIII. Authorized Official

Name: DR. YOON MO MYUNG
Title or Position: OWNER
Credential: MD
Phone: 740-645-7881