MEDICARE: DR. HEESUK RICHARD YOON M.D.

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	2086S0129X	Vascular Surgery Physician	MD444891	PA
2	2086S0129X	Vascular Surgery Physician	49586	TN

General Provider Information

NPI Number	:	1841499191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEESUK RICHARD YOON M.D.

Provider Business Mailing Address
First Line	:	2 PROFESSIONAL PARK DR
Second Line	:	SUITE 11
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6583
Country	:	US
Telephone Number	:	423-434-0642
Fax Number	:	423-434-9963

Provider Business Practice Location Address
First Line	:	2428 KNOB CREEK RD STE 201
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2396
Country	:	US
Telephone Number	:	423-282-5054
Fax Number	:	423-283-0516

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	02/12/2018

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