Provider Demographics
NPI:1083431530
Name:MO, MICHELLE KANG YUN (FNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KANG YUN
Last Name:MO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19125 RADBY ST
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3039
Mailing Address - Country:US
Mailing Address - Phone:626-638-3817
Mailing Address - Fax:
Practice Address - Street 1:2020 S BREA CANYON RD STE A1
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4012
Practice Address - Country:US
Practice Address - Phone:909-861-6853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95026122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine