Basic Information
| Provider Information | |||||||||
| NPI: | 1700398872 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YOO | ||||||||
| FirstName: | SUNG WON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2240 ANDREWS DR | ||||||||
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| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928335632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147916967 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9353 VALLEY BLVD | ||||||||
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| City: | ROSEMEAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917701923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262872988 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2017 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 225C00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor |
No ID Information.