Provider Demographics
NPI:1750628145
Name:YOU, SANGYEON
Entity Type:Individual
Prefix:
First Name:SANGYEON
Middle Name:
Last Name:YOU
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 1:1361 N GILBERT ST APT 178
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2146
Mailing Address - Country:US
Mailing Address - Phone:909-771-9917
Mailing Address - Fax:
Practice Address - Street 1:1361 N GILBERT ST APT 178
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-2146
Practice Address - Country:US
Practice Address - Phone:909-771-9917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14032171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist