Provider Demographics
NPI:1417934316
Name:YOO, PAUL BYOUNGJAE (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BYOUNGJAE
Last Name:YOO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N. HARBOR BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2400
Mailing Address - Country:US
Mailing Address - Phone:714-758-0185
Mailing Address - Fax:714-758-0759
Practice Address - Street 1:1150 N HARBOR BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2400
Practice Address - Country:US
Practice Address - Phone:714-758-0185
Practice Address - Fax:714-758-0759
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT-110408LTG152W00000X
CAOPT11408T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV00076Medicare UPIN