MEDICARE: DR. MIYOUNG 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	100183	CA
2	1223G0001X	General Practice Dentistry	100183	CA

General Provider Information

NPI Number	:	1902165202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIYOUNG YOON DDS

Provider Business Mailing Address
First Line	:	2607 FOOTHILL BLVD
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-3511
Country	:	US
Telephone Number	:	818-688-7646
Fax Number	:

Provider Business Practice Location Address
First Line	:	2607 FOOTHILL BLVD
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-3511
Country	:	US
Telephone Number	:	818-688-7646
Fax Number	:

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

Provider Enumeration Date	:	05/08/2012
Last Update Date	:	04/14/2020

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