Provider Demographics
NPI:1205945169
Name:YOON, JASON INSOO (DMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:INSOO
Last Name:YOON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:INSOO
Other - Middle Name:
Other - Last Name:KWAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1024 SW HIGHLAND DR
Mailing Address - Street 2:#A
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-6353
Mailing Address - Country:US
Mailing Address - Phone:503-492-7798
Mailing Address - Fax:503-492-9020
Practice Address - Street 1:1024 SW HIGHLAND DR
Practice Address - Street 2:#A
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-6353
Practice Address - Country:US
Practice Address - Phone:503-492-7798
Practice Address - Fax:503-492-9020
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist