Healthcare Provider Details

I. General information

NPI: 1518683903
Provider Name (Legal Business Name): LYDIA YUN DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CIRO AVE
SUITE201 CA
95128-1671
US

IV. Provider business mailing address

PO BOX 321086
LOS GATOS CA
95032-0118
US

V. Phone/Fax

Practice location:
  • Phone: 408-947-2500
  • Fax: 408-947-3480
Mailing address:
  • Phone: 408-796-7689
  • Fax: 408-340-5905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: LYDIA YUN
Title or Position: MD/OWNER
Credential: DPM
Phone: 408-947-2500