Provider Demographics
NPI:1386634228
Name:YOON, SUNNY (OD)
Entity Type:Individual
Prefix:DR
First Name:SUNNY
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3625
Mailing Address - Country:US
Mailing Address - Phone:978-745-2803
Mailing Address - Fax:978-745-9317
Practice Address - Street 1:88 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3625
Practice Address - Country:US
Practice Address - Phone:978-745-2803
Practice Address - Fax:978-745-9317
Is Sole Proprietor?:No
Enumeration Date:2005-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0392081Medicaid
MA0392081Medicaid