MEDICARE: MR. JUN SOO YOON

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	1223P0221X	Pediatric Dentistry	063930-01	NY

General Provider Information

NPI Number	:	1295479434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUN SOO YOON

Provider Business Mailing Address
First Line	:	111 E 210TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3209 82ND ST FL 1
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-2003
Country	:	US
Telephone Number	:	718-898-0600
Fax Number	:

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

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	10/29/2025

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