Provider Demographics
NPI:1174697197
Name:LYOU, YOON (DMD)
Entity type:Individual
Prefix:DR
First Name:YOON
Middle Name:
Last Name:LYOU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 OLD YORK RD
Mailing Address - Street 2:STE 4
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001
Mailing Address - Country:US
Mailing Address - Phone:215-657-4440
Mailing Address - Fax:215-657-2412
Practice Address - Street 1:1550 OLD YORK RD
Practice Address - Street 2:STE 4
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001
Practice Address - Country:US
Practice Address - Phone:215-657-4440
Practice Address - Fax:215-657-2412
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0363471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101208535Medicaid
PA101208535Medicare ID - Type Unspecified