Provider Demographics
NPI:1801363759
Name:YOON, JOHN (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:YOON
Suffix:
Gender:M
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13155 MESA VERDE WAY
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-3451
Mailing Address - Country:US
Mailing Address - Phone:747-777-7023
Mailing Address - Fax:
Practice Address - Street 1:400 S SEPULVEDA BLVD STE 247
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6876
Practice Address - Country:US
Practice Address - Phone:310-798-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17385171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC17385OtherCALIFORNIA ACUPUNCTURE BOARD