Provider Demographics
NPI:1518462738
Name:YUN, MISOOK (NP)
Entity type:Individual
Prefix:
First Name:MISOOK
Middle Name:
Last Name:YUN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 MENTONE AVE APT 413841
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3113
Mailing Address - Country:US
Mailing Address - Phone:310-733-9845
Mailing Address - Fax:
Practice Address - Street 1:3841 MENTONE AVE APT 413841
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3113
Practice Address - Country:US
Practice Address - Phone:310-733-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95008028363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95008028Medicaid