Provider Demographics
NPI:1184365181
Name:YOUM, SEONG WON (DDS, MPH)
Entity type:Individual
Prefix:DR
First Name:SEONG WON
Middle Name:
Last Name:YOUM
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:KIM
Other - Last Name:YOUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MPH
Mailing Address - Street 1:119 WINDSOR ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3648
Mailing Address - Country:US
Mailing Address - Phone:617-665-3990
Mailing Address - Fax:
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1099
Practice Address - Country:US
Practice Address - Phone:617-665-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859857122300000X
390200000X
NY063198122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program