Provider Demographics
NPI:1033297916
Name:YOON, YEGI KELLIE (MD)
Entity Type:Individual
Prefix:
First Name:YEGI
Middle Name:KELLIE
Last Name:YOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N BRAND BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1906
Mailing Address - Country:US
Mailing Address - Phone:818-265-6183
Mailing Address - Fax:
Practice Address - Street 1:505 N BRAND BLVD
Practice Address - Street 2:SUITE 900
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1906
Practice Address - Country:US
Practice Address - Phone:818-265-6183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67037208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics