Provider Demographics
NPI:1619417425
Name:YU, YOUNG JOO (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:JOO
Last Name:YU
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 PASO DEL LAGOS
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003-4904
Mailing Address - Country:US
Mailing Address - Phone:949-378-7235
Mailing Address - Fax:
Practice Address - Street 1:3910 PASO DEL LAGOS
Practice Address - Street 2:
Practice Address - City:BONSALL
Practice Address - State:CA
Practice Address - Zip Code:92003-4904
Practice Address - Country:US
Practice Address - Phone:949-378-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 17072171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist