Provider Demographics
NPI:1417167800
Name:YUN, SONG MIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SONG
Middle Name:MIN
Last Name:YUN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 OKEMOS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3235
Mailing Address - Country:US
Mailing Address - Phone:517-347-0777
Mailing Address - Fax:517-347-8788
Practice Address - Street 1:4111 OKEMOS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3235
Practice Address - Country:US
Practice Address - Phone:517-347-0777
Practice Address - Fax:517-347-8788
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010172121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice