Provider Demographics
NPI:1306284468
Name:TAE RIM YOON DMD PLLC
Entity type:Organization
Organization Name:TAE RIM YOON DMD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAE RIM
Authorized Official - Middle Name:
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-894-3493
Mailing Address - Street 1:20806 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8417
Mailing Address - Country:US
Mailing Address - Phone:425-286-2078
Mailing Address - Fax:425-408-1659
Practice Address - Street 1:20806 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8417
Practice Address - Country:US
Practice Address - Phone:425-286-2078
Practice Address - Fax:425-408-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60156209261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental