MEDICARE: DR. YONG JUN DOM

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	171100000X	Acupuncturist	AC17118	CA

General Provider Information

NPI Number	:	1790133635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YONG JUN DOM

Provider Business Mailing Address
First Line	:	6939 SUNRISE BLVD STE 226
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-3153
Country	:	US
Telephone Number	:	916-677-9818
Fax Number	:	916-251-7314

Provider Business Practice Location Address
First Line	:	6939 SUNRISE BLVD STE 226
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-3153
Country	:	US
Telephone Number	:	916-677-9818
Fax Number	:	916-251-7314

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

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	10/16/2019

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