Provider Demographics
NPI:1548758618
Name:YOON, ALICE HAE LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:HAE LEE
Last Name:YOON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2843 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3836
Mailing Address - Country:US
Mailing Address - Phone:818-649-4872
Mailing Address - Fax:
Practice Address - Street 1:2843 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3836
Practice Address - Country:US
Practice Address - Phone:818-649-4872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant