Healthcare Provider Details

I. General information

NPI: 1376235663
Provider Name (Legal Business Name): MC ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 BROADWAY
EVERETT WA
98201-1719
US

IV. Provider business mailing address

1429 BROADWAY
EVERETT WA
98201-1719
US

V. Phone/Fax

Practice location:
  • Phone: 425-212-1713
  • Fax:
Mailing address:
  • Phone: 425-212-1713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: LEWINA YEASEUL YOUN
Title or Position: OWNER
Credential:
Phone: 425-318-4787