Provider Demographics
NPI:1689154791
Name:YOON, JOSEPH (SUPPORT SPECIALIST)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:YOON
Suffix:
Gender:M
Credentials:SUPPORT SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 SAN MARINO ST APT 24
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1444
Mailing Address - Country:US
Mailing Address - Phone:213-357-8167
Mailing Address - Fax:
Practice Address - Street 1:600 ST PAUL AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-5660
Practice Address - Country:US
Practice Address - Phone:213-483-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker