Healthcare Provider Details

I. General information

NPI: 1790857431
Provider Name (Legal Business Name): Y.Y. WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 NEWPORT CENTER DR STE 20
NEWPORT BEACH CA
92660-7506
US

IV. Provider business mailing address

220 NEWPORT CENTER DR STE 20
NEWPORT BEACH CA
92660-7506
US

V. Phone/Fax

Practice location:
  • Phone: 949-718-0012
  • Fax: 949-718-0012
Mailing address:
  • Phone: 949-718-0012
  • Fax: 949-718-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberAC8452
License Number StateCA

VIII. Authorized Official

Name: DR. WOO H. CHUNG
Title or Position: PRESIDENT
Credential: L.AC.,PHD
Phone: 949-718-0012