Healthcare Provider Details

I. General information

NPI: 1780476671
Provider Name (Legal Business Name): JAE JUN YOU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 E WASHINGTON AVE
MADISON WI
53704-4301
US

IV. Provider business mailing address

309 W JOHNSON ST APT 341
MADISON WI
53703-3514
US

V. Phone/Fax

Practice location:
  • Phone: 608-244-8050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number14230037-9926
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6001932-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: