MEDICARE: JIWON JAY 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	1223G0001X	General Practice Dentistry	D15359	MN

General Provider Information

NPI Number	:	1528526555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIWON JAY YOON

Provider Business Mailing Address
First Line	:	8410 DATAPOINT DRIVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229
Country	:	US
Telephone Number	:	210-949-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	8410 DATAPOINT DR FL 3
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3220
Country	:	US
Telephone Number	:	210-617-5300
Fax Number	:

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

Provider Enumeration Date	:	03/08/2019
Last Update Date	:	05/20/2026

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