Provider Demographics
NPI:1710235429
Name:GO, YU WOUNG (LAC)
Entity Type:Individual
Prefix:MRS
First Name:YU WOUNG
Middle Name:
Last Name:GO
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 1:6540 LUSK BLVD
Mailing Address - Street 2:STE C265
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2767
Mailing Address - Country:US
Mailing Address - Phone:858-412-4403
Mailing Address - Fax:858-412-5647
Practice Address - Street 1:6540 LUSK BLVD
Practice Address - Street 2:STE C265
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2767
Practice Address - Country:US
Practice Address - Phone:858-412-4403
Practice Address - Fax:858-412-5647
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14161171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist