Provider Demographics
NPI:1205885563
Name:YOON, JAEYOUNG (MD)
Entity type:Individual
Prefix:
First Name:JAEYOUNG
Middle Name:
Last Name:YOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 MEYER RD
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3800
Mailing Address - Country:US
Mailing Address - Phone:314-230-1500
Mailing Address - Fax:314-230-1122
Practice Address - Street 1:1060 MEYER RD
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3800
Practice Address - Country:US
Practice Address - Phone:314-230-1500
Practice Address - Fax:314-230-1122
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115101207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H58016Medicare UPIN
MO209106905Medicaid