Healthcare Provider Details

I. General information

NPI: 1386802569
Provider Name (Legal Business Name): JANET SO-YUNG YUN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2008
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 917-882-6484
  • Fax:
Mailing address:
  • Phone: 408-795-3619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number19662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: