1548307077 NPI number — DR. YOON K TAK DMD

Table of content: DR. YOON K TAK DMD (NPI 1548307077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548307077 NPI number — DR. YOON K TAK DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAK
Provider First Name:
YOON
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

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:
1548307077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5115 LAKE RIDGE PKWY # 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND PRAIRIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75052-3098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-522-0660
Provider Business Mailing Address Fax Number:
972-522-0572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5115 LAKERIDGE PARKWAY
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
GRAND PRAIRIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-522-0660
Provider Business Practice Location Address Fax Number:
972-522-0572
Provider Enumeration Date:
02/01/2007

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: 1223P0221X , with the licence number:  23670 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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