Provider Demographics
NPI:1235304999
Name:JOO, SAM HYUN (CAS)
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:HYUN
Last Name:JOO
Suffix:
Gender:M
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1636 W GARDENA BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4725
Mailing Address - Country:US
Mailing Address - Phone:310-768-3028
Mailing Address - Fax:
Practice Address - Street 1:680 S WILTON PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-3200
Practice Address - Country:US
Practice Address - Phone:213-365-7400
Practice Address - Fax:213-383-1280
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator