Provider Demographics
NPI:1821091661
Name:YOON, EUN JOO (MD)
Entity Type:Individual
Prefix:MRS
First Name:EUN
Middle Name:JOO
Last Name:YOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 W OLYMPIC BLVD STE 101B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2998
Mailing Address - Country:US
Mailing Address - Phone:213-480-1000
Mailing Address - Fax:213-386-0211
Practice Address - Street 1:2560 W OLYMPIC BLVD STE 101B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2998
Practice Address - Country:US
Practice Address - Phone:213-480-1000
Practice Address - Fax:213-386-0211
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54010207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A540100Medicaid
CA11007046OtherCAQH
CAA54010OtherLICENSE
BY4880438OtherDEA
CA00A540100Medicaid
CAA54010OtherLICENSE