Provider Demographics
NPI:1194892646
Name:YOO, KWEON Y (AC)
Entity type:Individual
Prefix:
First Name:KWEON
Middle Name:Y
Last Name:YOO
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3053 W OLYMPIC BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2558
Mailing Address - Country:US
Mailing Address - Phone:213-251-9911
Mailing Address - Fax:213-380-3922
Practice Address - Street 1:3053 W OLYMPIC BLVD STE 305
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2558
Practice Address - Country:US
Practice Address - Phone:213-251-9911
Practice Address - Fax:213-380-3922
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6721171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC6721OtherLICENSE