=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417144270
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID K YOON MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2007
-----------------------------------------------------
Last Update Date | 03/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1180 W GRANADA BLVD SUITE B
-----------------------------------------------------
City | ORMOND BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32174-8165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-676-2606
-----------------------------------------------------
Fax | 386-672-5341
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1180 W GRANADA BLVD SUITE B
-----------------------------------------------------
City | ORMOND BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32174-8165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-676-2606
-----------------------------------------------------
Fax | 386-672-5341
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DOLORES VANDERMAELEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 386-677-2606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------