Provider Demographics
NPI:1649580259
Name:MOON, JOCELYN YUNSOO (PA-C, MPH)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:YUNSOO
Last Name:MOON
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:YUNSOO
Other - Last Name:SHIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPH
Mailing Address - Street 1:222 W EULALIA ST STE 100A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2850
Mailing Address - Country:US
Mailing Address - Phone:818-244-8161
Mailing Address - Fax:818-244-5122
Practice Address - Street 1:222 W EULALIA ST STE 100A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2850
Practice Address - Country:US
Practice Address - Phone:818-244-8161
Practice Address - Fax:818-244-5122
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21287363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant