Provider Demographics
NPI:1750690467
Name:SHON, YOUNG JOON (DDS)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:JOON
Last Name:SHON
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 1:2448 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4039
Mailing Address - Country:US
Mailing Address - Phone:917-951-8657
Mailing Address - Fax:
Practice Address - Street 1:20 BROADWAY
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5006
Practice Address - Country:US
Practice Address - Phone:917-951-8657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2016-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055223-1122300000X
NJ22DI02423600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist