Provider Demographics
NPI:1740010602
Name:YOO, KONNIE K (LAC)
Entity type:Individual
Prefix:
First Name:KONNIE
Middle Name:K
Last Name:YOO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 S ST ANDREWS PL APT 106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4410
Mailing Address - Country:US
Mailing Address - Phone:213-435-5714
Mailing Address - Fax:
Practice Address - Street 1:1200 ALTA LOMA RD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-2404
Practice Address - Country:US
Practice Address - Phone:213-435-5714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC20091171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist