Provider Demographics
NPI:1902230832
Name:KOO, YOONA (PHARMD, BCGP)
Entity Type:Individual
Prefix:
First Name:YOONA
Middle Name:
Last Name:KOO
Suffix:
Gender:F
Credentials:PHARMD, BCGP
Other - Prefix:
Other - First Name:YOONA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, BCGP
Mailing Address - Street 1:1150 S WESTMORELAND AVE APT 113
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3492
Mailing Address - Country:US
Mailing Address - Phone:347-622-2035
Mailing Address - Fax:
Practice Address - Street 1:1150 S. WESTMORELAND AVE. APT. 113
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006
Practice Address - Country:US
Practice Address - Phone:845-208-3328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69347183500000X
ORRPH-0017.766183500000X
NY991079221835G0303X
NY20058522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric