Provider Demographics
NPI:1023176229
Name:YI, DONG JOON (MD)
Entity type:Individual
Prefix:MR
First Name:DONG
Middle Name:JOON
Last Name:YI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1058 S VERMONT AVE
Mailing Address - Street 2:227
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2721
Mailing Address - Country:US
Mailing Address - Phone:213-368-6025
Mailing Address - Fax:213-368-6047
Practice Address - Street 1:1058 S VERMONT AVE
Practice Address - Street 2:227
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2721
Practice Address - Country:US
Practice Address - Phone:213-368-6025
Practice Address - Fax:213-368-6047
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2019-05-08
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Provider Licenses
StateLicense IDTaxonomies
CAA37857208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A378571Medicaid