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NPI Code Detail

MEDICARE: JAE YOUL SON

MEDICARE: JAE YOUL SON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC 40845CA

General Provider Information

NPI Number : 1124143805
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAE YOUL SON
Provider Business Mailing Address
First Line : 1665 W ADAMS BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90007-1533
Country : US
Telephone Number : 323-731-3534
Fax Number : 323-731-5618
Provider Business Practice Location Address
First Line : 1665 W ADAMS BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90007-1533
Country : US
Telephone Number : 323-731-3534
Fax Number : 323-731-5618
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 06/13/2011

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Directions to “ JAE YOUL SON ” Practice Location

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