Provider Demographics
NPI:1730178369
Name:YOUN, ELISABETH SUNGHEE (DPM)
Entity type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:SUNGHEE
Last Name:YOUN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 29034
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-0034
Mailing Address - Country:US
Mailing Address - Phone:213-483-6563
Mailing Address - Fax:213-483-6560
Practice Address - Street 1:1711 W TEMPLE ST STE 6657
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-7338
Practice Address - Country:US
Practice Address - Phone:213-483-6563
Practice Address - Fax:213-483-6560
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4458213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4458COtherMEDICARE LICENSE NUMBER
CA000E44580Medicaid
CA5068320001Medicare NSC
CA000E44580Medicaid