Provider Demographics
NPI:1255517280
Name:GREGORY K. YUN
Entity type:Organization
Organization Name:GREGORY K. YUN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:YUN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-638-7410
Mailing Address - Street 1:13071 BROOKHURST ST.
Mailing Address - Street 2:#130
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843
Mailing Address - Country:US
Mailing Address - Phone:714-638-7410
Mailing Address - Fax:714-638-7420
Practice Address - Street 1:13071 BROOKHURST ST.
Practice Address - Street 2:SUITE #130
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843
Practice Address - Country:US
Practice Address - Phone:714-638-7410
Practice Address - Fax:714-638-7420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23414AMedicare UPIN
CAW14687Medicare PIN