Provider Demographics
NPI:1023348885
Name:OWEN, SOOK YUN
Entity type:Individual
Prefix:MISS
First Name:SOOK
Middle Name:YUN
Last Name:OWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 S KARLA DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3295
Mailing Address - Country:US
Mailing Address - Phone:928-788-2488
Mailing Address - Fax:
Practice Address - Street 1:1648 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7906
Practice Address - Country:US
Practice Address - Phone:928-758-4114
Practice Address - Fax:928-758-4650
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3521363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health