Provider Demographics
NPI:1124471768
Name:YOON, SOYOON
Entity type:Individual
Prefix:MS
First Name:SOYOON
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17060 HIDDEN TRAILS LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-6795
Mailing Address - Country:US
Mailing Address - Phone:216-855-1525
Mailing Address - Fax:
Practice Address - Street 1:17060 HIDDEN TRAILS LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-6795
Practice Address - Country:US
Practice Address - Phone:216-855-1525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW64762101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health