Healthcare Provider Details

I. General information

NPI: 1295856631
Provider Name (Legal Business Name): JOHN C. YOON MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST SUITE B-0400
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST SUITE B-0400
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 617-413-2298
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberL-221259
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: