MEDICARE: SOYOUNG THOUVENIN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	683170	CA

General Provider Information

NPI Number	:	1609235969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOYOUNG THOUVENIN RN

Provider Business Mailing Address
First Line	:	5430 ZARA AVE
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-1446
Country	:	US
Telephone Number	:	510-565-8315
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 BANCROFT WAY # MC4300
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94720-1446
Country	:	US
Telephone Number	:	510-565-8315
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	02/15/2016

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