Provider Demographics
NPI:1124150412
Name:SUKHOON YOON, MD, PA
Entity type:Organization
Organization Name:SUKHOON YOON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SUKHOON
Authorized Official - Middle Name:
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-731-6121
Mailing Address - Street 1:PO BOX 16278
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76162-0278
Mailing Address - Country:US
Mailing Address - Phone:817-731-6121
Mailing Address - Fax:817-732-8015
Practice Address - Street 1:5001 MONARDA WAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-1813
Practice Address - Country:US
Practice Address - Phone:817-731-6121
Practice Address - Fax:817-732-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD5879OtherMEDICARE RAILROAD
TX0025KQOtherTX BCBS GROUP NUMBER
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=========OtherTAX ID NUMBER