Provider Demographics
NPI:1003477167
Name:COMPREHENSIVE PODIATRIC CARE INC
Entity Type:Organization
Organization Name:COMPREHENSIVE PODIATRIC CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEONG
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-434-0044
Mailing Address - Street 1:21409 DEVONSHIRE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2935
Mailing Address - Country:US
Mailing Address - Phone:818-527-1605
Mailing Address - Fax:818-979-8258
Practice Address - Street 1:21409 DEVONSHIRE ST STE 101
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2935
Practice Address - Country:US
Practice Address - Phone:818-527-1605
Practice Address - Fax:818-979-8258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4519OtherMED LICENSE