Provider Demographics
NPI:1265501324
Name:YOON, HAE Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAE
Middle Name:Y
Last Name:YOON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3415
Mailing Address - Country:US
Mailing Address - Phone:847-866-7430
Mailing Address - Fax:847-866-7432
Practice Address - Street 1:1819 CHURCH ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3415
Practice Address - Country:US
Practice Address - Phone:847-866-7430
Practice Address - Fax:847-866-7432
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9175784Medicaid