Provider Demographics
NPI:1588198865
Name:SHIN NONG CLINIC
Entity Type:Organization
Organization Name:SHIN NONG CLINIC
Other - Org Name:SHIN NONG ACUPUNCTURE & HERBS
Other - Org Type:Other Name
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:DO YEOL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC,OMD,PHD
Authorized Official - Phone:661-947-7795
Mailing Address - Street 1:826 E PALMDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4710
Mailing Address - Country:US
Mailing Address - Phone:661-947-7795
Mailing Address - Fax:661-947-7796
Practice Address - Street 1:826 E PALMDALE BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4710
Practice Address - Country:US
Practice Address - Phone:661-947-7795
Practice Address - Fax:661-947-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5086171100000X
CA26484171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty