Provider Demographics
NPI:1518117431
Name:YOU, JAEWOO (LAC)
Entity Type:Individual
Prefix:
First Name:JAEWOO
Middle Name:
Last Name:YOU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:238 S SERRANO AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5261
Mailing Address - Country:US
Mailing Address - Phone:213-820-2773
Mailing Address - Fax:323-978-4348
Practice Address - Street 1:5001 WILSHIRE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-6104
Practice Address - Country:US
Practice Address - Phone:323-877-6420
Practice Address - Fax:323-978-4348
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-27
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12608171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist