Healthcare Provider Details

I. General information

NPI: 1952580706
Provider Name (Legal Business Name): BONNIE YUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 N MILLBROOK AVE
FRESNO CA
93703-1425
US

IV. Provider business mailing address

3133 N MILLBROOK AVE
FRESNO CA
93703-1425
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9891
  • Fax: 559-600-7701
Mailing address:
  • Phone: 559-600-9891
  • Fax: 559-600-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number83205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: