Provider Demographics
NPI:1578773792
Name:SONG M. YUN, D.D.S., P.C.
Entity Type:Organization
Organization Name:SONG M. YUN, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONG
Authorized Official - Middle Name:MIN
Authorized Official - Last Name:YUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-347-0777
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI291010172121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty