Healthcare Provider Details

I. General information

NPI: 1245690791
Provider Name (Legal Business Name): YOONIE HYUNJUNG JO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 MAIN ST
HUNTINGTON BEACH CA
92648-2475
US

IV. Provider business mailing address

2040 CAMFIELD AVE
COMMERCE CA
90040-1574
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-9303
  • Fax:
Mailing address:
  • Phone: 562-493-9581
  • Fax: 888-499-9303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: