Provider Demographics
NPI:1396776811
Name:YOO, WON S (DC)
Entity type:Individual
Prefix:DR
First Name:WON
Middle Name:S
Last Name:YOO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281-13TH ST.
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612
Mailing Address - Country:US
Mailing Address - Phone:510-465-8707
Mailing Address - Fax:510-465-8660
Practice Address - Street 1:281 13TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3900
Practice Address - Country:US
Practice Address - Phone:510-465-8707
Practice Address - Fax:510-465-8660
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 0290250Medicare ID - Type Unspecified
CADC 0290251Medicare ID - Type UnspecifiedSECOND OFFICE