Provider Demographics
NPI:1548523764
Name:YOON, JENNIFER YOUNHEE (DDS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:YOUNHEE
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 1:11629 COACHMANS CARRIAGE PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-8511
Mailing Address - Country:US
Mailing Address - Phone:646-265-6821
Mailing Address - Fax:
Practice Address - Street 1:4722 N SOUTHSIDE PLAZA ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-1742
Practice Address - Country:US
Practice Address - Phone:804-533-7634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856036122300000X, 1223G0001X
VA04014164851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist