Provider Demographics
NPI:1093408262
Name:YOON, KEONSEOK (AUD)
Entity Type:Individual
Prefix:
First Name:KEONSEOK
Middle Name:
Last Name:YOON
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 RIVER WAY APT J
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1724
Mailing Address - Country:US
Mailing Address - Phone:860-786-8343
Mailing Address - Fax:
Practice Address - Street 1:2240 N HARBOR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2635
Practice Address - Country:US
Practice Address - Phone:714-447-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT743231H00000X
CA3850231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist