Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 53114 | CA |
Y | 1223X0400X | Orthodontists | 53114 | CA |
NPI | 1083865646 |
---|---|
Provider Name | Dr. Audrey Jung-Sun Yoon |
First Address | Stanford, CA 94305-2200 |
Second Address | Stanford, CA 94305-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2008 |
Last Update Date | 16/02/2021 |