Provider Demographics
NPI:1649813239
Name:YOUNG, YEONSOO JULIE (PA-C)
Entity type:Individual
Prefix:
First Name:YEONSOO
Middle Name:JULIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:YEONSOO
Other - Middle Name:JULIE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:15025 HUNTERS GATE CIR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6218
Mailing Address - Country:US
Mailing Address - Phone:714-673-1290
Mailing Address - Fax:
Practice Address - Street 1:5885 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1863
Practice Address - Country:US
Practice Address - Phone:800-270-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58309363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant