Provider Demographics
NPI:1275088213
Name:YOUN, SEONGMI
Entity Type:Individual
Prefix:
First Name:SEONGMI
Middle Name:
Last Name:YOUN
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 1:138 S KENMORE AVE APT A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5663
Mailing Address - Country:US
Mailing Address - Phone:213-712-4452
Mailing Address - Fax:
Practice Address - Street 1:138 S KENMORE AVE APT A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5663
Practice Address - Country:US
Practice Address - Phone:213-712-4452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17199171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist