Provider Demographics
NPI:1649800061
Name:YOON, MIJO
Entity type:Individual
Prefix:
First Name:MIJO
Middle Name:
Last Name:YOON
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 1:12505 WOODSON BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-5105
Mailing Address - Country:US
Mailing Address - Phone:661-472-3122
Mailing Address - Fax:661-665-2998
Practice Address - Street 1:12505 WOODSON BRIDGE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-5105
Practice Address - Country:US
Practice Address - Phone:661-472-3122
Practice Address - Fax:661-665-2998
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD1821701343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)