Provider Demographics
NPI:1962723775
Name:YOON, SU MI (DMD)
Entity type:Individual
Prefix:DR
First Name:SU
Middle Name:MI
Last Name:YOON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SUE
Other - Middle Name:SU-MI
Other - Last Name:YOON LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1019 112TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-4875
Mailing Address - Country:US
Mailing Address - Phone:425-551-6001
Mailing Address - Fax:
Practice Address - Street 1:1019 112TH ST SW
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-4875
Practice Address - Country:US
Practice Address - Phone:425-551-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60167859122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist