MEDICARE: STACEY J YUN

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	106H00000X	Marriage & Family Therapist	145765	CA

General Provider Information

NPI Number	:	1972174738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY J YUN

Provider Business Mailing Address
First Line	:	550 S GRAMERCY PL APT 107
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-4997
Country	:	US
Telephone Number	:	213-999-6916
Fax Number	:

Provider Business Practice Location Address
First Line	:	8919 CALIFORNIA AVE
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-3013
Country	:	US
Telephone Number	:	213-999-6916
Fax Number	:

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

Provider Enumeration Date	:	07/02/2021
Last Update Date	:	01/03/2025

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Directions to “ STACEY J YUN ” Practice Location

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