MEDICARE: HONG SUK YOON 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	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1518958693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HONG SUK YOON D.D.S.

Provider Business Mailing Address
First Line	:	333 E. RT 83
Second Line	:	101
City	:	MUNDELEIN
State	:	IL
Zip	:	60060
Country	:	US
Telephone Number	:	847-566-7212
Fax Number	:	847-566-7216

Provider Business Practice Location Address
First Line	:	333 E IL ROUTE 83
Second Line	:	101
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-4214
Country	:	US
Telephone Number	:	847-566-7212
Fax Number	:	847-566-7216

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	01/03/2008

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