Provider Demographics
NPI:1689972291
Name:JEONG, YOUNIL (LAC)
Entity Type:Individual
Prefix:
First Name:YOUNIL
Middle Name:
Last Name:JEONG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4325
Mailing Address - Country:US
Mailing Address - Phone:408-393-6128
Mailing Address - Fax:866-684-5747
Practice Address - Street 1:693 E REMINGTON DR
Practice Address - Street 2:#A
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1977
Practice Address - Country:US
Practice Address - Phone:408-393-6128
Practice Address - Fax:866-684-5747
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-05
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13974171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist