Provider Demographics
NPI:1871649061
Name:YOO, SEUNGHOON (LAC)
Entity Type:Individual
Prefix:
First Name:SEUNGHOON
Middle Name:
Last Name:YOO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 GRISMER AVE
Mailing Address - Street 2:# 99
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-3719
Mailing Address - Country:US
Mailing Address - Phone:818-955-8293
Mailing Address - Fax:
Practice Address - Street 1:826 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-2808
Practice Address - Country:US
Practice Address - Phone:626-968-0806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11297171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0112970Medicaid