Provider Demographics
NPI:1265844807
Name:YOON, JAJUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAJUNG
Middle Name:
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 1:219 COURTHOUSE RD SE
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6811
Mailing Address - Country:US
Mailing Address - Phone:848-565-5070
Mailing Address - Fax:
Practice Address - Street 1:219 COURTHOUSE RD SE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6811
Practice Address - Country:US
Practice Address - Phone:848-565-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021257122300000X
NMDD44031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist