Healthcare Provider Details

I. General information

NPI: 1851175038
Provider Name (Legal Business Name): YOUN HONG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DUARTE RD
DUARTE CA
91010-3012
US

IV. Provider business mailing address

7353 ELLENA W UNIT 186
RANCHO CUCAMONGA CA
91730-8382
US

V. Phone/Fax

Practice location:
  • Phone: 877-460-4673
  • Fax:
Mailing address:
  • Phone: 909-732-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number68816
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPENDING
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: