1073842183 NPI number — CHARITY MORRIS YOON

Table of content: CHARITY MORRIS YOON (NPI 1073842183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073842183 NPI number — CHARITY MORRIS YOON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOON
Provider First Name:
CHARITY
Provider Middle Name:
MORRIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073842183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 BARTON RD
Provider Second Line Business Mailing Address:
APT 3102
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92373-5306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-240-9461
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23905 CLINTON KEITH RD
Provider Second Line Business Practice Location Address:
#114
Provider Business Practice Location Address City Name:
WILDOMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92595-7897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-672-7673
Provider Business Practice Location Address Fax Number:
951-672-1197
Provider Enumeration Date:
12/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  20666 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20666 . This is a "PHYSICIAN ASSISTANT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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