Provider Demographics
NPI:1508350380
Name:YOON, KYUBO (DDS)
Entity Type:Individual
Prefix:
First Name:KYUBO
Middle Name:
Last Name:YOON
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 1:5 NORTHTOWN WAY
Mailing Address - Street 2:SUITE 2114
Mailing Address - City:TORONTO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M2N 7A1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 MAIN STREET
Practice Address - Street 2:SUITE PH1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044
Practice Address - Country:US
Practice Address - Phone:647-298-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2020-02-10
Deactivation Date:2019-01-25
Deactivation Code:
Reactivation Date:2019-01-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program