Healthcare Provider Details

I. General information

NPI: 1932660693
Provider Name (Legal Business Name): CINDY SE YEON YOUN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FLORIDA AVE
MODESTO CA
95350-4418
US

IV. Provider business mailing address

4329 W 190TH ST
TORRANCE CA
90504-5510
US

V. Phone/Fax

Practice location:
  • Phone: 559-494-4030
  • Fax: 559-334-3145
Mailing address:
  • Phone: 310-365-1116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number322612
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number64251
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A21678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: