Healthcare Provider Details

I. General information

NPI: 1548685373
Provider Name (Legal Business Name): YOUNG JEREMIAH YOON, DMD, RPH II, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9910 LEVIN RD NW
SILVERDALE WA
98383-7789
US

IV. Provider business mailing address

9910 LEVIN RD NW
SILVERDALE WA
98383-7789
US

V. Phone/Fax

Practice location:
  • Phone: 360-698-1990
  • Fax:
Mailing address:
  • Phone: 360-698-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60128169
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE60128169
License Number StateWA

VIII. Authorized Official

Name: YOUNG J YOON
Title or Position: OWNER
Credential: DMD, RPH
Phone: 360-698-1990