Provider Demographics
NPI:1275560732
Name:YOUN AND MANNAN LLC
Entity Type:Organization
Organization Name:YOUN AND MANNAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:JOO
Authorized Official - Last Name:YOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-761-1424
Mailing Address - Street 1:1410 CRAIN HIGHWAY NORTH
Mailing Address - Street 2:UNIT 5A
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-761-1424
Mailing Address - Fax:410-761-0301
Practice Address - Street 1:1410 CRAIN HIGHWAY NORTH
Practice Address - Street 2:UNIT 5A
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-761-1424
Practice Address - Fax:410-761-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56044208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD787931800Medicaid
MD787931800Medicaid