Provider Demographics
NPI:1487402129
Name:YOO, SANG IL (ACUPUNCTURIST)
Entity type:Individual
Prefix:MR
First Name:SANG IL
Middle Name:
Last Name:YOO
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 S SERRANO AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2590
Mailing Address - Country:US
Mailing Address - Phone:213-296-7314
Mailing Address - Fax:
Practice Address - Street 1:1138 S SERRANO AVE APT 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2590
Practice Address - Country:US
Practice Address - Phone:213-296-7314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12135171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist