Healthcare Provider Details

I. General information

NPI: 1275228678
Provider Name (Legal Business Name): JI WON YOON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE YOON DDS

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15808 MILL CREEK BLVD
MILL CREEK WA
98012-1500
US

IV. Provider business mailing address

109 GRASSLANDS LN
REDWOOD CITY CA
94065-7430
US

V. Phone/Fax

Practice location:
  • Phone: 425-318-4787
  • Fax:
Mailing address:
  • Phone: 760-212-9171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number70131335
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: