Provider Demographics
NPI:1629195656
Name:YUN, JASMINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:
Last Name:YUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12409 VENTURA CT STE C
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2471
Mailing Address - Country:US
Mailing Address - Phone:818-900-6007
Mailing Address - Fax:818-900-6607
Practice Address - Street 1:12409 VENTURA CT STE C
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2471
Practice Address - Country:US
Practice Address - Phone:818-900-6007
Practice Address - Fax:818-900-6607
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81846207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI34656Medicare UPIN
CACA127YMedicare PIN