Provider Demographics
NPI:1750920559
Name:KEUM, YOUNG SOON (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:YOUNG
Middle Name:SOON
Last Name:KEUM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16793
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96151-6793
Mailing Address - Country:US
Mailing Address - Phone:530-545-8782
Mailing Address - Fax:
Practice Address - Street 1:1001 PYRAMID WAY STE 206
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-4470
Practice Address - Country:US
Practice Address - Phone:775-710-8380
Practice Address - Fax:949-543-2069
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV832549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily