Provider Demographics
NPI:1235472754
Name:YOUN, EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:YOUN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:650-845-7649
Mailing Address - Fax:
Practice Address - Street 1:4053 LONE TREE WAY STE 200
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531
Practice Address - Country:US
Practice Address - Phone:925-776-7725
Practice Address - Fax:510-506-7728
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEL5217213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17021OtherAMERICAN BOARD OF FOOT & ANKLE SURGERY
CAE5217OtherSTATE MEDICAL LICENSE