Healthcare Provider Details

I. General information

NPI: 1992716641
Provider Name (Legal Business Name): PAUL S YOON D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46408 VIANNE CT
TEMECULA CA
92592-3328
US

IV. Provider business mailing address

46408 VIANNE CT
TEMECULA CA
92592-3328
US

V. Phone/Fax

Practice location:
  • Phone: 760-689-2038
  • Fax:
Mailing address:
  • Phone: 760-689-2038
  • Fax: 760-990-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4455
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE4455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: