Provider Demographics
NPI:1982905519
Name:YI, JOO-YOUN (DDS)
Entity type:Individual
Prefix:
First Name:JOO-YOUN
Middle Name:
Last Name:YI
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:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-0180
Mailing Address - Country:US
Mailing Address - Phone:269-783-2495
Mailing Address - Fax:269-782-4925
Practice Address - Street 1:58620 SINK RD
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-9329
Practice Address - Country:US
Practice Address - Phone:269-783-2495
Practice Address - Fax:269-782-4925
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016011231223G0001X
CA593921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice