Provider Demographics
NPI:1619314556
Name:SOUNG, GEORGE YI JAAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:YI JAAN
Last Name:SOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 PARK SOUTH STATION BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4473
Mailing Address - Country:US
Mailing Address - Phone:724-244-2628
Mailing Address - Fax:
Practice Address - Street 1:11840 SOUTHMORE DR STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0785
Practice Address - Country:US
Practice Address - Phone:704-246-6051
Practice Address - Fax:704-246-6967
Is Sole Proprietor?:No
Enumeration Date:2013-06-02
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95331223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery