Provider Demographics
NPI:1548402035
Name:SHIN, YOUN JUNG (LAC)
Entity Type:Individual
Prefix:DR
First Name:YOUN
Middle Name:JUNG
Last Name:SHIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 W OLYMPIC BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2089
Mailing Address - Country:US
Mailing Address - Phone:213-726-7812
Mailing Address - Fax:213-221-3713
Practice Address - Street 1:2300 W OLYMPIC BLVD STE 218
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2089
Practice Address - Country:US
Practice Address - Phone:213-726-7812
Practice Address - Fax:213-221-3713
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12368171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist