Provider Demographics
NPI:1962391763
Name:YOON, RA (LAC)
Entity type:Individual
Prefix:MRS
First Name:RA
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:RA
Other - Middle Name:
Other - Last Name:YOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:280 MADISON AVE RM 1211
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0809
Mailing Address - Country:US
Mailing Address - Phone:212-884-1110
Mailing Address - Fax:
Practice Address - Street 1:280 MADISON AVE RM 1211
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0809
Practice Address - Country:US
Practice Address - Phone:212-884-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007728-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist