Provider Demographics
NPI:1497722342
Name:YOON, MYEONG S (MD)
Entity Type:Individual
Prefix:
First Name:MYEONG
Middle Name:S
Last Name:YOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S GARNETT RD STE 112
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5201
Mailing Address - Country:US
Mailing Address - Phone:918-935-3550
Mailing Address - Fax:
Practice Address - Street 1:4500 S GARNETT RD STE 112
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5201
Practice Address - Country:US
Practice Address - Phone:918-935-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY431872085R0202X
OK214652085R0202X
FLME763652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100258130CMedicaid
OK100258130CMedicaid
KY0169Medicare PIN