Provider Demographics
NPI:1972539781
Name:YOON, SHANNON S (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:S
Last Name:YOON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25124 NARBONNE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2142
Mailing Address - Country:US
Mailing Address - Phone:310-530-3260
Mailing Address - Fax:
Practice Address - Street 1:25124 NARBONNE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2142
Practice Address - Country:US
Practice Address - Phone:310-530-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice