Provider Demographics
NPI:1073588927
Name:YOON, SANG H (DC)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:H
Last Name:YOON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 S HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3013
Mailing Address - Country:US
Mailing Address - Phone:323-930-2242
Mailing Address - Fax:
Practice Address - Street 1:2017 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3705
Practice Address - Country:US
Practice Address - Phone:213-480-1000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV08110Medicare UPIN
CADC29859Medicare ID - Type Unspecified