Provider Demographics
NPI:1831352418
Name:YOON, JESSICA (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4547 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3155
Mailing Address - Country:US
Mailing Address - Phone:503-481-5043
Mailing Address - Fax:
Practice Address - Street 1:2770 ARAPAHOE RD STE 132-1036
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8018
Practice Address - Country:US
Practice Address - Phone:303-566-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108361207N00000X
ORMD171107207N00000X
NMMD2017-0862207N00000X
CAC156843207N00000X
CODR.0060211207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology