MEDICARE: DR. ELISABETH SUNGHEE YOUN D.P.M.

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	213E00000X	Podiatrist	E4458	CA

General Provider Information

NPI Number	:	1730178369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISABETH SUNGHEE YOUN D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 29034
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-0034
Country	:	US
Telephone Number	:	213-483-6563
Fax Number	:	213-483-6560

Provider Business Practice Location Address
First Line	:	1711 W TEMPLE ST STE 6657
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-7338
Country	:	US
Telephone Number	:	213-483-6563
Fax Number	:	213-483-6560

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	10/12/2022

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