Provider Demographics
NPI:1306229638
Name:CHON, SO YOUNG
Entity Type:Individual
Prefix:
First Name:SO YOUNG
Middle Name:
Last Name:CHON
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 1:85 BRECKINRIDGE SQ
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1422
Mailing Address - Country:US
Mailing Address - Phone:502-417-1487
Mailing Address - Fax:
Practice Address - Street 1:85 BRECKINRIDGE SQ
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1422
Practice Address - Country:US
Practice Address - Phone:502-417-1487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist