Provider Demographics
NPI:1942555859
Name:YI, YOUNG S (DMD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:S
Last Name:YI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 BOSTON POST RD W
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-4605
Mailing Address - Country:US
Mailing Address - Phone:508-481-8161
Mailing Address - Fax:
Practice Address - Street 1:290 BAKER AVE STE N228
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2192
Practice Address - Country:US
Practice Address - Phone:978-369-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857550122300000X, 1223P0221X
NJ22DI02579901122300000X
NJ22DI02579902122300000X
NJ063551223P0221X
NJ06355-011223P0221X
NJ06355-021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ06355OtherPEDIATRIC DENTIST - SPECIALTY PERMIT