Provider Demographics
NPI:1376547281
Name:YOEUN, KUN NOUN
Entity type:Individual
Prefix:
First Name:KUN
Middle Name:NOUN
Last Name:YOEUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 E PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-5626
Mailing Address - Country:US
Mailing Address - Phone:562-218-7784
Mailing Address - Fax:562-218-7686
Practice Address - Street 1:916 E PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-5626
Practice Address - Country:US
Practice Address - Phone:562-218-7784
Practice Address - Fax:562-218-7686
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-09
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CAPHY 467141835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03094FMedicaid
CA4252310001Medicare NSC