Provider Demographics
NPI:1538705256
Name:YOO, ANDREW JEUNG
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JEUNG
Last Name:YOO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26063 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6506
Mailing Address - Country:US
Mailing Address - Phone:951-567-3703
Mailing Address - Fax:
Practice Address - Street 1:425 S SUNRISE WAY STE A
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7664
Practice Address - Country:US
Practice Address - Phone:760-327-4381
Practice Address - Fax:760-327-4388
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78493183500000X
CARPH784931835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist