Provider Demographics
NPI:1043366818
Name:YI, YOUNG SUN
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:SUN
Last Name:YI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 W OLYMPIC BLVD
Mailing Address - Street 2:200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2567
Mailing Address - Country:US
Mailing Address - Phone:213-385-4545
Mailing Address - Fax:213-385-0450
Practice Address - Street 1:3000 W OLYMPIC BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2516
Practice Address - Country:US
Practice Address - Phone:213-385-4545
Practice Address - Fax:213-385-0450
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32144207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A321442Medicaid
CA00A321442Medicaid
CAA32144BMedicare ID - Type UnspecifiedNHIC MEDICARE