MEDICARE: JOONG-KU YOON DDS

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	D11723	MN

General Provider Information

NPI Number	:	1841254034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOONG-KU YOON DDS

Provider Business Mailing Address
First Line	:	1313 PENN AVENUE NORTH
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411
Country	:	US
Telephone Number	:	612-302-4600
Fax Number	:	612-302-4870

Provider Business Practice Location Address
First Line	:	1313 PENN AVENUE NORTH
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411
Country	:	US
Telephone Number	:	612-302-4600
Fax Number	:	612-302-4870

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	07/08/2007

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