Provider Demographics
NPI:1922683770
Name:STEPHAN YOON DMD INC
Entity type:Organization
Organization Name:STEPHAN YOON DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:PURNOMO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:415-859-8135
Mailing Address - Street 1:113 WATERWORKS WAY STE 215
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3176
Mailing Address - Country:US
Mailing Address - Phone:949-412-5734
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY STE 215
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3176
Practice Address - Country:US
Practice Address - Phone:949-412-5734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty