Basic Information
Provider Information
NPI: 1447631650
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YOON
FirstName: SARAH
MiddleName: MEE
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2901 JOLLY RD
Address2:  
City: PLYMOUTH MEETING
State: PA
PostalCode: 194622324
CountryCode: US
TelephoneNumber: 6102728221
FaxNumber:  
Practice Location
Address1: 2901 JOLLY RD
Address2:  
City: PLYMOUTH MEETING
State: PA
PostalCode: 194622324
CountryCode: US
TelephoneNumber: 4439490814
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/12/2015
LastUpdateDate: 10/26/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/26/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XMA059203PAN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363AM0700XMA059203PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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