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General NPI Number Information
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NPI Number | 1063888279
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Entity Type | Individual
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Provider Name | YOONJI AN
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Gender | Female
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 9850 S MARYLAND PKWY STE 3
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City | LAS VEGAS
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State | NV
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Zip | 89183-7148
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Country | US
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Telephone | 702-914-9990
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Fax |
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Provider Business Mailing Address
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Address Line | 833 LORD CREWE ST
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City | LAS VEGAS
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State | NV
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Zip | 89138-6035
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Country | US
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Telephone | 702-503-8683
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6633
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License Number State | NV
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