Provider Demographics
NPI:1477595155
Name:IM, MOON YOUNG VI (DC)
Entity Type:Individual
Prefix:DR
First Name:MOON YOUNG
Middle Name:
Last Name:IM
Suffix:VI
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2800
Mailing Address - Country:US
Mailing Address - Phone:213-383-0007
Mailing Address - Fax:866-621-2931
Practice Address - Street 1:2655 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2800
Practice Address - Country:US
Practice Address - Phone:213-383-0007
Practice Address - Fax:866-621-2931
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor