Provider Demographics
NPI:1821200882
Name:HARROLL, YOUN S (OMD)
Entity Type:Individual
Prefix:DR
First Name:YOUN
Middle Name:S
Last Name:HARROLL
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:DR
Other - First Name:YOUN
Other - Middle Name:S
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OMD
Mailing Address - Street 1:6376 SPRING MOUNTAIN RD STE 6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-8818
Mailing Address - Country:US
Mailing Address - Phone:702-888-1713
Mailing Address - Fax:702-888-1713
Practice Address - Street 1:6376 SPRING MOUNTAIN RD STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-8818
Practice Address - Country:US
Practice Address - Phone:702-888-1713
Practice Address - Fax:702-888-1713
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2009171100000X
P227606252171100000X
CAAC11394171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVC20170905-1319OtherNEVADA
NVC20170905-1319OtherNEVADA TAX ID NUMBER