1801950449 NPI number — DR. GWI YOUNG YOON DDS

Table of content: DR. GWI YOUNG YOON DDS (NPI 1801950449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801950449 NPI number — DR. GWI YOUNG YOON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOON
Provider First Name:
GWI YOUNG
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOON
Provider Other First Name:
SUNNI
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1801950449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1245 TRAVIS BLVD
Provider Second Line Business Mailing Address:
STE C D
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-422-7003
Provider Business Mailing Address Fax Number:
707-422-7013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1245 TRAVIS BLVD
Provider Second Line Business Practice Location Address:
STE C D
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-422-7003
Provider Business Practice Location Address Fax Number:
707-422-7013
Provider Enumeration Date:
12/20/2006

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: 122300000X , with the licence number:  47681 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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