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General NPI Number Information
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NPI Number | 1750920559
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Entity Type | Individual
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Provider Name | YOUNG SOON KEUM FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/27/2019
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 1001 PYRAMID WAY STE 206
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City | SPARKS
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State | NV
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Zip | 89431-4470
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Country | US
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Telephone | 775-710-8380
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Fax | 949-543-2069
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Provider Business Mailing Address
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Address Line | PO BOX 16793
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96151-6793
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Country | US
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Telephone | 530-545-8782
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 832549
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License Number State | NV
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