Provider Demographics
NPI:1083700595
Name:YOON, SIMON W (DMD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:W
Last Name:YOON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 W CHESTER PIKE
Mailing Address - Street 2:STE 1000A
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4652
Mailing Address - Country:US
Mailing Address - Phone:610-356-9424
Mailing Address - Fax:610-356-0397
Practice Address - Street 1:3400 W CHESTER PIKE
Practice Address - Street 2:STE 1000A
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4652
Practice Address - Country:US
Practice Address - Phone:610-356-9424
Practice Address - Fax:610-356-0397
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030688Y1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice