Provider Demographics
NPI:1912215435
Name:SOON YULL KWUN,M.D.,INC
Entity Type:Organization
Organization Name:SOON YULL KWUN,M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:YULL
Authorized Official - Last Name:KWUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-442-2151
Mailing Address - Street 1:3131 SANTA ANITA AVE
Mailing Address - Street 2:105
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-1369
Mailing Address - Country:US
Mailing Address - Phone:626-442-2151
Mailing Address - Fax:626-442-1666
Practice Address - Street 1:3131 SANTA ANITA AVE
Practice Address - Street 2:105
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1369
Practice Address - Country:US
Practice Address - Phone:626-442-2151
Practice Address - Fax:626-442-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A330480Medicaid
CA00A330480Medicaid
CAA33048Medicare PIN