Provider Demographics
NPI:1376777060
Name:YOON, SOONJA LEIBELT (DOM)
Entity type:Individual
Prefix:DR
First Name:SOONJA
Middle Name:LEIBELT
Last Name:YOON
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7034 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-4948
Mailing Address - Country:US
Mailing Address - Phone:813-476-3336
Mailing Address - Fax:813-885-6600
Practice Address - Street 1:7034 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4948
Practice Address - Country:US
Practice Address - Phone:813-476-3336
Practice Address - Fax:813-885-6600
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP-1193171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC-0422OtherBC/BS OF FLORIDA