Healthcare Provider Details

I. General information

NPI: 1902230832
Provider Name (Legal Business Name): YOONA KOO PHARM.D., BCGP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YOONA LEE PHARM.D., BCGP

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 02/18/2024
Certification Date: 02/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S. WESTMORELAND AVE. APT. 113
LOS ANGELES CA
90006
US

IV. Provider business mailing address

1150 S WESTMORELAND AVE APT 113
LOS ANGELES CA
90006-3492
US

V. Phone/Fax

Practice location:
  • Phone: 845-208-3328
  • Fax:
Mailing address:
  • Phone: 347-622-2035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69347
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0017.766
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number99107922
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20058522
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: