Provider Demographics
NPI:1104850882
Name:YUNAN RADIOLOGY MEDICAL GROUP INC
Entity type:Organization
Organization Name:YUNAN RADIOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEONG
Authorized Official - Middle Name:SOO
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-954-0145
Mailing Address - Street 1:903 S CRENSHAW BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1965
Mailing Address - Country:US
Mailing Address - Phone:323-954-0145
Mailing Address - Fax:323-954-0270
Practice Address - Street 1:903 S CRENSHAW BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1965
Practice Address - Country:US
Practice Address - Phone:323-954-0145
Practice Address - Fax:323-954-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA358072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W10692Medicare ID - Type Unspecified
W84816Medicare UPIN