Provider Demographics
NPI:1982856522
Name:SON, SU YEON (LAC)
Entity Type:Individual
Prefix:
First Name:SU YEON
Middle Name:
Last Name:SON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-4216
Mailing Address - Country:US
Mailing Address - Phone:714-321-0939
Mailing Address - Fax:
Practice Address - Street 1:3207 S BREA CANYON RD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3458
Practice Address - Country:US
Practice Address - Phone:909-595-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12387171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist