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General NPI Number Information
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NPI Number | 1275858169
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Entity Type | Individual
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Provider Name | TAE LIM YOUN DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2010
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 1429 BROADWAY
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City | EVERETT
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State | WA
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Zip | 98201-1719
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Country | US
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Telephone | 425-318-4789
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Fax |
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Provider Business Mailing Address
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Address Line | 1429 BROADWAY
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City | EVERETT
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State | WA
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Zip | 98201-1719
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Country | US
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Telephone | 425-318-4789
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | MD60644029
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 58655
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE60634547
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License Number State | WA
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