Provider Demographics
NPI:1104361757
Name:DAVID YOO DMD INC
Entity Type:Organization
Organization Name:DAVID YOO DMD INC
Other - Org Name:PRIME CARE DENTAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DONGSHIN
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-463-6163
Mailing Address - Street 1:8803 WHITTIER BLVD #200
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-7400
Mailing Address - Country:US
Mailing Address - Phone:562-463-6163
Mailing Address - Fax:562-395-7693
Practice Address - Street 1:8803 WHITTIER BLVD #200
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-7400
Practice Address - Country:US
Practice Address - Phone:562-463-6163
Practice Address - Fax:562-395-7693
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID YOO DMD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty