Provider Demographics
NPI:1801950449
Name:YOON, GWI YOUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:GWI YOUNG
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUNNI
Other - Middle Name:G
Other - Last Name:YOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1245 TRAVIS BLVD
Mailing Address - Street 2:STE C D
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533
Mailing Address - Country:US
Mailing Address - Phone:707-422-7003
Mailing Address - Fax:707-422-7013
Practice Address - Street 1:1245 TRAVIS BLVD
Practice Address - Street 2:STE C D
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533
Practice Address - Country:US
Practice Address - Phone:707-422-7003
Practice Address - Fax:707-422-7013
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47681122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist