Provider Demographics
NPI:1417219155
Name:YOUN, LEWINA YEASEUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEWINA
Middle Name:YEASEUL
Last Name:YOUN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:YEASEUL
Other - Middle Name:KIM
Other - Last Name:YOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15808 MILL CREEK BLVD
Mailing Address - Street 2:202
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1500
Mailing Address - Country:US
Mailing Address - Phone:425-318-4787
Mailing Address - Fax:
Practice Address - Street 1:15808 MILL CREEK BLVD
Practice Address - Street 2:202
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1500
Practice Address - Country:US
Practice Address - Phone:425-318-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 606345291223E0200X
CA613781223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics