Provider Demographics
NPI:1629291596
Name:YOON, SOON AI (LAC OMD)
Entity Type:Individual
Prefix:
First Name:SOON
Middle Name:AI
Last Name:YOON
Suffix:
Gender:F
Credentials:LAC OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 PLEASANT OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2567
Mailing Address - Country:US
Mailing Address - Phone:925-935-5480
Mailing Address - Fax:925-313-9100
Practice Address - Street 1:395 TAYLOR BLVD
Practice Address - Street 2:SUITE #115
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2286
Practice Address - Country:US
Practice Address - Phone:925-457-7640
Practice Address - Fax:925-313-9100
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9678171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
81-0664578OtherTAX ID