Provider Demographics
NPI:1154631448
Name:MAHONEY, YOUNG OK
Entity type:Individual
Prefix:
First Name:YOUNG OK
Middle Name:
Last Name:MAHONEY
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 1:432 S MANHATTAN PL
Mailing Address - Street 2:APT #14
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4159
Mailing Address - Country:US
Mailing Address - Phone:213-703-0552
Mailing Address - Fax:
Practice Address - Street 1:432 S SAN VICENTE BLVD
Practice Address - Street 2:#250
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4183
Practice Address - Country:US
Practice Address - Phone:213-703-0552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13608171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 13608OtherACUPUNCTURE LICENSE