=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649527920
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WON R. YOON M.D. & SOO Y. SONG-YOON M.D. INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2012
-----------------------------------------------------
Last Update Date | 08/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3323 W OLYMPIC BLVD 201
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90019-2339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-733-0121
-----------------------------------------------------
Fax | 323-733-0295
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3323 W OLYMPIC BLVD 201
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90019-2339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-733-0121
-----------------------------------------------------
Fax | 323-733-0295
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WON R. YOON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 323-733-0121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A29584
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A29576
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------