MEDICARE: DR. YOUN S HARROLL OMD

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	2009	NV
2	171100000X	Acupuncturist	P227606252
3	171100000X	Acupuncturist	AC11394	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C20170905-1319	OTHER	NV	NEVADA
2	C20170905-1319	OTHER	NV	NEVADA TAX ID NUMBER

General Provider Information

NPI Number	:	1821200882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOUN S HARROLL OMD

Provider Business Mailing Address
First Line	:	6376 SPRING MOUNTAIN RD STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8818
Country	:	US
Telephone Number	:	702-888-1713
Fax Number	:	702-888-1713

Provider Business Practice Location Address
First Line	:	6376 SPRING MOUNTAIN RD STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8818
Country	:	US
Telephone Number	:	702-888-1713
Fax Number	:	702-888-1713

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	06/16/2018

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