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General NPI Number Information
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NPI Number | 1780476671
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Entity Type | Individual
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Provider Name | JAE JUN YOU D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 3003 E WASHINGTON AVE
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City | MADISON
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State | WI
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Zip | 53704-4301
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Country | US
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Telephone | 608-244-8050
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Fax |
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Provider Business Mailing Address
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Address Line | 309 W JOHNSON ST APT 341
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City | MADISON
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State | WI
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Zip | 53703-3514
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 14230037-9926
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6001932-15
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License Number State | WI
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