Provider Demographics
NPI:1316918022
Name:YOUN, YOUNGSUK (OD)
Entity type:Individual
Prefix:
First Name:YOUNGSUK
Middle Name:
Last Name:YOUN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39150 CITATION PL
Mailing Address - Street 2:APT 34102
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-4900
Mailing Address - Country:US
Mailing Address - Phone:248-661-4706
Mailing Address - Fax:
Practice Address - Street 1:35184 CENTRAL CITY PKWY
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-6215
Practice Address - Country:US
Practice Address - Phone:734-427-5200
Practice Address - Fax:734-427-8136
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004231152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management