Provider Demographics
NPI:1679197016
Name:TAE YOUN DDS MD PLLC
Entity Type:Organization
Organization Name:TAE YOUN DDS MD PLLC
Other - Org Name:EVERETT ORAL AND IMPLANT SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:TAE LIM
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:425-318-4789
Mailing Address - Street 1:15808 MILL CREEK BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1500
Mailing Address - Country:US
Mailing Address - Phone:425-318-4789
Mailing Address - Fax:
Practice Address - Street 1:1429 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1719
Practice Address - Country:US
Practice Address - Phone:425-318-4789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty