=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629291596
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOON AI YOON L.AC. O.M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2007
-----------------------------------------------------
Last Update Date | 02/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 395 TAYLOR BLVD SUITE #115
-----------------------------------------------------
City | PLEASANT HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94523-2286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-457-7640
-----------------------------------------------------
Fax | 925-313-9100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1004 PLEASANT OAKS DR
-----------------------------------------------------
City | PLEASANT HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94523-2567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-935-5480
-----------------------------------------------------
Fax | 925-313-9100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 9678
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------