Provider Demographics
NPI:1801934146
Name:YOON, TIMOTHY (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:YOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 5TH ST
Mailing Address - Street 2:APT 112
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-2665
Mailing Address - Country:US
Mailing Address - Phone:916-715-2737
Mailing Address - Fax:
Practice Address - Street 1:1817 PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2106
Practice Address - Country:US
Practice Address - Phone:916-977-0741
Practice Address - Fax:916-977-0547
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64572208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA64572OtherMEDICAL LINCENSE NUMBER
CAP00302519OtherRAIL ROAD MEDICARE
CA127169100OtherACS-US DEPT OF LABOR
CAA64572OtherMEDICAL LINCENSE NUMBER