1033282777 NPI number — JUSTIN K YOON M.D.

Table of content: JUSTIN K YOON M.D. (NPI 1033282777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033282777 NPI number — JUSTIN K YOON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOON
Provider First Name:
JUSTIN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033282777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17382 SE 54TH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98006-5919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-761-4200
Provider Business Mailing Address Fax Number:
253-383-3553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17382 SE 54TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98006-5919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-310-7710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X , with the licence number:  00037000 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD00037000 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G8881872 . This is a "PTAN-MIO1" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AB36535 . This is a "MEDICARE PIN TRA KING COUNTY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AB37885 . This is a "MEDICARE PIN ADVANCED OPEN IMAGING" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0249559 . This is a "LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7252YO . This is a "REGENCE BLUE SHIELD UNION AVENUE OPEN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8951825 . This is a "LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 158188 . This is a "LABOR AND INDUSTRIES/WC TRA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1940YO . This is a "REGENCE BLUE SHIELD ADVANCED OPEN IMAGING" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8296378 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 170311 . This is a "LABOR AND INDUSTRIES/WC ADVANCED OPEN IMAGING" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 300128232 . This is a "RR MEDICARE TRA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 158190 . This is a "LABOR AND INDUSTRIES/WC UNION AVENUE OPEN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 3231YO . This is a "REGENCE BLUE SHIELD TRA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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