Provider Demographics
NPI:1376071555
Name:YOON, SOON JO
Entity Type:Individual
Prefix:MR
First Name:SOON
Middle Name:JO
Last Name:YOON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8083 KERR GRN
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1340
Mailing Address - Country:US
Mailing Address - Phone:714-616-4512
Mailing Address - Fax:
Practice Address - Street 1:1911 COMMERCE TERM DR.EAST SUITE 107
Practice Address - Street 2:
Practice Address - City:SAN BERNADINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:714-616-4512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14498171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist