Provider Demographics
NPI:1811973878
Name:YOON, JOANNE B (OD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:B
Last Name:YOON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:YOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2525 THREEWOODS LN
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1060
Mailing Address - Country:US
Mailing Address - Phone:714-928-0927
Mailing Address - Fax:
Practice Address - Street 1:11900 SOUTH ST STE 121
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6800
Practice Address - Country:US
Practice Address - Phone:562-809-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12676152W00000X
CA12676T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W18718Medicare ID - Type Unspecified
V04731Medicare UPIN