Healthcare Provider Details

I. General information

NPI: 1194008532
Provider Name (Legal Business Name): BONNIE YOO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 S DIAMOND BAR BLVD STE 722
DIAMOND BAR CA
91765-2203
US

IV. Provider business mailing address

1142 S DIAMOND BAR BLVD STE 722
DIAMOND BAR CA
91765-2203
US

V. Phone/Fax

Practice location:
  • Phone: 213-282-8164
  • Fax:
Mailing address:
  • Phone: 213-282-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number74593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: