Provider Demographics
NPI:1417344037
Name:YOUN, JUVENTIA LAY (NP)
Entity type:Individual
Prefix:
First Name:JUVENTIA
Middle Name:LAY
Last Name:YOUN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JUVENTIA
Other - Middle Name:
Other - Last Name:LAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2800 MONTELLANO AVE
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-5943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11003 LAKEWOOD BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3876
Practice Address - Country:US
Practice Address - Phone:562-869-1038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily