Provider Demographics
NPI:1417144270
Name:DAVID K YOON MD PA
Entity Type:Organization
Organization Name:DAVID K YOON MD PA
Other - Org Name:JENA MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERMAELEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-677-2606
Mailing Address - Street 1:1180 W GRANADA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8165
Mailing Address - Country:US
Mailing Address - Phone:386-676-2606
Mailing Address - Fax:386-672-5341
Practice Address - Street 1:1180 W GRANADA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8165
Practice Address - Country:US
Practice Address - Phone:386-676-2606
Practice Address - Fax:386-672-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD20749Medicare UPIN
FLK3404Medicare PIN