MEDICARE: DR. DUSTIN Y YOON M.D., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	125059828	IL
2	193400000X	Single Specialty Group	D814945	MD

General Provider Information

NPI Number	:	1073839833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTIN Y YOON M.D., M.S.

Provider Business Mailing Address
First Line	:	20410 OBSERVATION DR
Second Line	:	STE 100
City	:	GERMANTOWN
State	:	MD
Zip	:	20876-6419
Country	:	US
Telephone Number	:	301-762-0277
Fax Number	:	301-330-9108

Provider Business Practice Location Address
First Line	:	20410 OBSERVATION DR
Second Line	:	STE 100
City	:	GERMANTOWN
State	:	MD
Zip	:	20876-6419
Country	:	US
Telephone Number	:	301-762-0277
Fax Number	:	301-330-9108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2010
Last Update Date	:	01/27/2017

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