Provider Demographics
NPI:1053721092
Name:SAM H. YOON, MD
Entity type:Organization
Organization Name:SAM H. YOON, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-214-1407
Mailing Address - Street 1:4161 REDONDO BEACH BLVD
Mailing Address - Street 2:#100
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3306
Mailing Address - Country:US
Mailing Address - Phone:310-214-1407
Mailing Address - Fax:
Practice Address - Street 1:4161 REDONDO BEACH BLVD
Practice Address - Street 2:#100
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3306
Practice Address - Country:US
Practice Address - Phone:310-214-1407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1063412005282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A33684Medicaid
CA00A336841Medicaid