Provider Demographics
NPI:1568004737
Name:YOO, BYUNG H
Entity Type:Individual
Prefix:
First Name:BYUNG
Middle Name:H
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 1:2101 W BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4417
Mailing Address - Country:US
Mailing Address - Phone:213-393-7779
Mailing Address - Fax:213-289-5321
Practice Address - Street 1:601 E YORBA LINDA BLVD STE 1E
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3006
Practice Address - Country:US
Practice Address - Phone:213-393-7779
Practice Address - Fax:213-289-5321
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC4309868251G00000X
CAC4314985251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Yes251G00000XAgenciesHospice Care, Community Based