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NPI Code Detail

MEDICARE: YEONSOO JULIE YOUNG PA-C

MEDICARE: YEONSOO JULIE YOUNG PA-C
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
1363A00000XPhysician Assistant58309CA

General Provider Information

NPI Number : 1649813239
Entity Type Code : Individual
Provider Name (Legal Business Name) : YEONSOO JULIE YOUNG PA-C
Provider Business Mailing Address
First Line : 15025 HUNTERS GATE CIR
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-6218
Country : US
Telephone Number : 714-673-1290
Fax Number :
Provider Business Practice Location Address
First Line : 5885 BROCKTON AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92506-1863
Country : US
Telephone Number : 800-270-5016
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2019
Last Update Date : 02/13/2025

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