Provider Demographics
NPI:1013917715
Name:YOON, PETER KONG-WOO (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:KONG-WOO
Last Name:YOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KONG-WOO
Other - Middle Name:PETER
Other - Last Name:YOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 297A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-6364
Mailing Address - Fax:314-251-7897
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:STE 297A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6364
Practice Address - Fax:314-251-7897
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3E52174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO261839808OtherCHAMPUS
MO06-01313OtherUNITED HEALTHCARE
MO261839808OtherMERCY HEALTH PLANS
MOP00663995OtherMEDICARE RAILROAD
MO119685OtherBLUE CROSS BLUE SHIELD
MO102280OtherHEALTHLINK PPO
MO261839808OtherGREAT WEST HEALTH CARE
MO337533OtherGROUP HEALTH PLAN
MO261839808OtherGREAT WEST HEALTH CARE