Healthcare Provider Details

I. General information

NPI: 1649580259
Provider Name (Legal Business Name): JOCELYN YUNSOO MOON PA-C, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOCELYN YUNSOO SHIM PA-C, MPH

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W EULALIA ST STE 100A
GLENDALE CA
91204-2850
US

IV. Provider business mailing address

222 W EULALIA ST STE 100A
GLENDALE CA
91204-2850
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-8161
  • Fax: 818-244-5122
Mailing address:
  • Phone: 818-244-8161
  • Fax: 818-244-5122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: