Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC23413 | CA |
NPI | 1568656486 |
---|---|
Provider Name | Dr. Louie Gwon Yu |
First Address | Tarzana, CA 91356-2803 |
Second Address | Tarzana, CA 91356-2803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2007 |
Last Update Date | 04/09/2007 |