Provider Demographics
NPI:1184659047
Name:WON, YOUNG TAIK (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:TAIK
Last Name:WON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3350 WILSHIRE BLVD
Mailing Address - Street 2:# 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1824
Mailing Address - Country:US
Mailing Address - Phone:213-383-5522
Mailing Address - Fax:213-383-1667
Practice Address - Street 1:3350 WILSHIRE BLVD
Practice Address - Street 2:# 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1824
Practice Address - Country:US
Practice Address - Phone:213-383-5522
Practice Address - Fax:213-383-1667
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA66733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA66733Medicaid
CAA66733Medicare ID - Type Unspecified
CAA66733Medicaid