Provider Demographics
NPI:1104694454
Name:YOO, JUN SANG (PHD)
Entity type:Individual
Prefix:DR
First Name:JUN
Middle Name:SANG
Last Name:YOO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 DOVE ST STE 305
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1447
Mailing Address - Country:US
Mailing Address - Phone:949-282-8991
Mailing Address - Fax:949-209-3284
Practice Address - Street 1:1600 DOVE ST STE 305
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1447
Practice Address - Country:US
Practice Address - Phone:949-282-8991
Practice Address - Fax:949-209-3284
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19963171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist