Provider Demographics
NPI:1437141587
Name:YOO, SUNG J (MD)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:J
Last Name:YOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18897 COLIMA RD
Mailing Address - Street 2:A
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2977
Mailing Address - Country:US
Mailing Address - Phone:626-913-1116
Mailing Address - Fax:626-913-1261
Practice Address - Street 1:18897 COLIMA RD STE A
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2977
Practice Address - Country:US
Practice Address - Phone:626-913-1116
Practice Address - Fax:626-913-1261
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78232207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098190Medicaid
W16932Medicare PIN
G23814Medicare UPIN