Provider Demographics
NPI:1821178757
Name:YOON, JASON HEUNGNO (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:HEUNGNO
Last Name:YOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 MARTIN LUTHER KING JR AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5821
Mailing Address - Country:US
Mailing Address - Phone:202-678-4940
Mailing Address - Fax:202-678-9703
Practice Address - Street 1:2345 MARTIN LUTHER KING JUNIOR AVENUE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7007
Practice Address - Country:US
Practice Address - Phone:202-678-4940
Practice Address - Fax:202-678-9703
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC7384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC023296700Medicaid
C61458Medicare UPIN
DC023296700Medicaid