Healthcare Provider Details

I. General information

NPI: 1477595155
Provider Name (Legal Business Name): MOON YOUNG IM VI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 W OLYMPIC BLVD SUITE 101
LOS ANGELES CA
90006-2800
US

IV. Provider business mailing address

2655 W OLYMPIC BLVD SUITE 101
LOS ANGELES CA
90006-2800
US

V. Phone/Fax

Practice location:
  • Phone: 213-383-0007
  • Fax: 866-621-2931
Mailing address:
  • Phone: 213-383-0007
  • Fax: 866-621-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: