Provider Demographics
NPI:1073842183
Name:YOON, CHARITY MORRIS
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:MORRIS
Last Name:YOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 BARTON RD
Mailing Address - Street 2:APT 3102
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5306
Mailing Address - Country:US
Mailing Address - Phone:323-240-9461
Mailing Address - Fax:
Practice Address - Street 1:23905 CLINTON KEITH RD
Practice Address - Street 2:#114
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7897
Practice Address - Country:US
Practice Address - Phone:951-672-7673
Practice Address - Fax:951-672-1197
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20666363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20666OtherPHYSICIAN ASSISTANT