Basic Information
| Provider Information | |||||||||
| NPI: | 1083674410 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YUN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | GLEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 SHELDON STREET | ||||||||
| Address2: | |||||||||
| City: | EL SEGUNDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902453915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103224278 | ||||||||
| FaxNumber: | 3103228251 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 SANTA MONICA BLVD STE 760W | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105827474 | ||||||||
| FaxNumber: | 3105827481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 04/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A79179 | CA | N | Other Service Providers | Specialist | 207X00000X | A79179 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.