Provider Demographics
NPI:1689563504
Name:YOON, SO YOUNG SALLY
Entity type:Individual
Prefix:
First Name:SO YOUNG
Middle Name:SALLY
Last Name:YOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5540
Mailing Address - Country:US
Mailing Address - Phone:213-808-9331
Mailing Address - Fax:
Practice Address - Street 1:754 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-2544
Practice Address - Country:US
Practice Address - Phone:213-820-3641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5291171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist