Provider Demographics
NPI:1053411918
Name:YOO, JUN SON (DDS)
Entity type:Individual
Prefix:
First Name:JUN SON
Middle Name:
Last Name:YOO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16920 FOOTHILL BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3592
Mailing Address - Country:US
Mailing Address - Phone:909-823-3300
Mailing Address - Fax:909-823-9391
Practice Address - Street 1:16920 FOOTHILL BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3592
Practice Address - Country:US
Practice Address - Phone:909-823-3300
Practice Address - Fax:909-823-9391
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA399211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice