MEDICARE: DR. STEVEN KI YUN D.D.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	1223G0001X	General Practice Dentistry	DI 20284	NJ
2	1223G0001X	General Practice Dentistry	047979	NY

General Provider Information

NPI Number	:	1336143684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN KI YUN D.D.S.

Provider Business Mailing Address
First Line	:	324 KNICKERBOCKER RD
Second Line	:
City	:	CRESSKILL
State	:	NJ
Zip	:	07626-1324
Country	:	US
Telephone Number	:	201-503-1240
Fax Number	:	201-503-1241

Provider Business Practice Location Address
First Line	:	324 KNICKERBOCKER RD
Second Line	:
City	:	CRESSKILL
State	:	NJ
Zip	:	07626-1324
Country	:	US
Telephone Number	:	201-503-1240
Fax Number	:	201-503-1241

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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