Provider Demographics
NPI:1366313280
Name:YOU, JIYONG NMN (DDS)
Entity type:Individual
Prefix:DR
First Name:JIYONG
Middle Name:NMN
Last Name:YOU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 RACE ST APT 2001
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1262
Mailing Address - Country:US
Mailing Address - Phone:901-338-2880
Mailing Address - Fax:
Practice Address - Street 1:100 CENTRE BLVD STE J
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4128
Practice Address - Country:US
Practice Address - Phone:856-983-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS045429122300000X
NJ22DI03122000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist