Provider Demographics
NPI:1689741456
Name:STOVER, YOON-SOOK (PA)
Entity Type:Individual
Prefix:MS
First Name:YOON-SOOK
Middle Name:
Last Name:STOVER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S. COLORADO BLVD
Mailing Address - Street 2:SUITE 220A
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1912
Mailing Address - Country:US
Mailing Address - Phone:303-453-2237
Mailing Address - Fax:303-453-2239
Practice Address - Street 1:9191 GRANT ST
Practice Address - Street 2:SUITE 418
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4361
Practice Address - Country:US
Practice Address - Phone:303-453-2237
Practice Address - Fax:303-453-2239
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO2360363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56630085Medicaid
CO56630085Medicaid
COCO301337Medicare PIN
COC810776Medicare PIN