Provider Demographics
NPI:1689988875
Name:YOO, MICKLE YANGHEE I
Entity Type:Individual
Prefix:MR
First Name:MICKLE
Middle Name:YANGHEE
Last Name:YOO
Suffix:I
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 1:11 CHARTHOUSE CV
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1663
Mailing Address - Country:US
Mailing Address - Phone:714-522-1177
Mailing Address - Fax:714-522-1177
Practice Address - Street 1:11 CHARTHOUSE CV
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1663
Practice Address - Country:US
Practice Address - Phone:714-522-1177
Practice Address - Fax:714-522-1177
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8Y42009343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)