Provider Demographics
NPI:1538100748
Name:YOON, JANGYEUL (DDS)
Entity Type:Individual
Prefix:
First Name:JANGYEUL
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 1:10807 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4730
Mailing Address - Country:US
Mailing Address - Phone:703-261-6999
Mailing Address - Fax:703-349-2575
Practice Address - Street 1:10807 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4730
Practice Address - Country:US
Practice Address - Phone:703-261-6999
Practice Address - Fax:703-349-2575
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0352891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001900640Medicaid
PA01388616OtherUNITED CONCORDIA
PA106688OtherDENTAL BENEFIT PROVIDERS
PA132759OtherUNISON
PA0015943OtherDORAL DENTAL
PADS035289OtherDELTA DENTAL