Provider Demographics
NPI:1346889110
Name:YOON, SOON AE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:SOON AE
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 BEACH BLVD. #104
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620
Mailing Address - Country:US
Mailing Address - Phone:213-215-0430
Mailing Address - Fax:714-821-9618
Practice Address - Street 1:8600 BEACH BLVD. #104
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620
Practice Address - Country:US
Practice Address - Phone:213-215-0430
Practice Address - Fax:714-821-9618
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18225171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist