Provider Demographics
NPI:1346467461
Name:KYUNG SOO YOO MD INC
Entity Type:Organization
Organization Name:KYUNG SOO YOO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KYUNG
Authorized Official - Middle Name:SOO
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-891-1616
Mailing Address - Street 1:15446 PARTHENIA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-5108
Mailing Address - Country:US
Mailing Address - Phone:818-891-1616
Mailing Address - Fax:818-895-2706
Practice Address - Street 1:15446 PARTHENIA ST
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5108
Practice Address - Country:US
Practice Address - Phone:818-891-1616
Practice Address - Fax:818-895-2706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA444720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A444720Medicaid
CAF18425Medicare UPIN