Provider Demographics
NPI:1467438002
Name:YOO, MI HWA (MD)
Entity Type:Individual
Prefix:DR
First Name:MI HWA
Middle Name:
Last Name:YOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13080 SOLOMON PEAK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-8404
Mailing Address - Country:US
Mailing Address - Phone:951-255-1796
Mailing Address - Fax:
Practice Address - Street 1:2815 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2531
Practice Address - Country:US
Practice Address - Phone:951-255-1796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78754208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG787540Medicaid
CAG11137Medicare UPIN
CA00G787540Medicare ID - Type Unspecified