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General NPI Number Information
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NPI Number | 1215235270
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Entity Type | Organization
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Legal Business Name | YOUNG JEREMIAH YOON, DMD,RPH, PC
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 4113 BRIDGEPORT WAY W SUITE A
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4325
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Country | US
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Telephone | 253-564-6341
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Fax |
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Provider Business Mailing Address
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Address Line | 4113 BRIDGEPORT WAY W SUITE A
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4325
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Country | US
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Telephone | 253-564-6341
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YOUNG J YOON
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Credential | DMD
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Telephone | 206-799-3351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 60128169
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License Number State | WA
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