Provider Demographics
NPI:1619246865
Name:YOO, JOHN JONG SOO (PHD, LAC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JONG SOO
Last Name:YOO
Suffix:
Gender:M
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-5802
Mailing Address - Country:US
Mailing Address - Phone:626-332-7476
Mailing Address - Fax:
Practice Address - Street 1:625 E ARROW HWY
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-5802
Practice Address - Country:US
Practice Address - Phone:626-332-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10160171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist