Provider Demographics
NPI:1598183808
Name:JOH, YONGMOON (LAC)
Entity Type:Individual
Prefix:MR
First Name:YONGMOON
Middle Name:
Last Name:JOH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 BEACON AVE
Mailing Address - Street 2:APT 111
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-2185
Mailing Address - Country:US
Mailing Address - Phone:213-447-7730
Mailing Address - Fax:
Practice Address - Street 1:731 S BEACON AVENUE APT 111
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017
Practice Address - Country:US
Practice Address - Phone:213-447-7730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14898171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist