Provider Demographics
NPI:1457563108
Name:YOON, SU JOONG (DDS)
Entity Type:Individual
Prefix:
First Name:SU
Middle Name:JOONG
Last Name:YOON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 GARDEN GROVE BLVD
Mailing Address - Street 2:#14
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1528
Mailing Address - Country:US
Mailing Address - Phone:714-537-9160
Mailing Address - Fax:714-839-5077
Practice Address - Street 1:9520 GARDEN GROVE BLVD
Practice Address - Street 2:#14
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1528
Practice Address - Country:US
Practice Address - Phone:714-537-9160
Practice Address - Fax:714-839-5077
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice