Basic Information
| Provider Information | |||||||||
| NPI: | 1437129327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YUN | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | INKOO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21ST STREET | ||||||||
| Address2: | USA DENTAC BLDG 2441 | ||||||||
| City: | FT CAMPBELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422235369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707988614 | ||||||||
| FaxNumber: | 2707988633 | ||||||||
| Practice Location | |||||||||
| Address1: | 21ST STREET | ||||||||
| Address2: | USA DENTAC BLDG 2441 | ||||||||
| City: | FT CAMPBELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422235369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707988614 | ||||||||
| FaxNumber: | 2707988614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 10/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 051631 | NY | N | Dental Providers | Dentist | 1223P0300X | 051631 | NY | Y | Dental Providers | Dentist | Periodontics |
No ID Information.