Provider Demographics
NPI:1437255817
Name:PAUL & ELIZABETH YOO, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PAUL & ELIZABETH YOO, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-665-9550
Mailing Address - Street 1:1300 N VERMONT AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6005
Mailing Address - Country:US
Mailing Address - Phone:323-655-9550
Mailing Address - Fax:323-665-1075
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-655-9550
Practice Address - Fax:323-665-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA401922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A401920Medicaid
CAA40192OtherCALIF. MEDICAL LICENSE
CAA40192OtherCALIF. MEDICAL LICENSE
ALW10709Medicare ID - Type Unspecified