Provider Demographics
NPI:1366491383
Name:YUN, KYU HO (MD)
Entity Type:Individual
Prefix:
First Name:KYU
Middle Name:HO
Last Name:YUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12828 HARBOR BL
Mailing Address - Street 2:#320
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-2005
Mailing Address - Country:US
Mailing Address - Phone:714-636-0133
Mailing Address - Fax:714-636-3833
Practice Address - Street 1:12828 HARBOR BL
Practice Address - Street 2:#320
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-2005
Practice Address - Country:US
Practice Address - Phone:714-636-0133
Practice Address - Fax:714-636-3833
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337450Medicaid
A33745Medicare PIN