Provider Demographics
NPI:1417170127
Name:YOON, JINNEY (L AC)
Entity Type:Individual
Prefix:
First Name:JINNEY
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7671 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2516
Mailing Address - Country:US
Mailing Address - Phone:410-917-8869
Mailing Address - Fax:
Practice Address - Street 1:7671 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2516
Practice Address - Country:US
Practice Address - Phone:410-917-8869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01529171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD56750001OtherCAREFIRST NCA PROF.
MD56750001OtherCAREFIRSTBLUECHICE POF
MD21ZRJ-89019301OtherCAREFIRST MD PROF.