Provider Demographics
NPI:1972918357
Name:YOO, KELVIN SUNGWON (DC)
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:SUNGWON
Last Name:YOO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:SUNG
Other - Middle Name:WON
Other - Last Name:YOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2772 PARADISE ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2281
Mailing Address - Country:US
Mailing Address - Phone:562-756-1391
Mailing Address - Fax:
Practice Address - Street 1:2772 PARADISE ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2281
Practice Address - Country:US
Practice Address - Phone:562-756-1391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor