Provider Demographics
NPI:1992716641
Name:YOON, PAUL S (DPM)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:YOON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46408 VIANNE CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3328
Mailing Address - Country:US
Mailing Address - Phone:760-689-2038
Mailing Address - Fax:760-990-4722
Practice Address - Street 1:46408 VIANNE CT
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3328
Practice Address - Country:US
Practice Address - Phone:760-689-2038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4455213EP1101X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00370483OtherRAILROAD MEDICARE
P00370483OtherRAILROAD MEDICARE
CA000E44550Medicare PIN
CAE4455Medicare PIN