Provider Demographics
NPI:1861507501
Name:SEONG M. YOO, DPM MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SEONG M. YOO, DPM MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEONG
Authorized Official - Middle Name:M
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-968-5882
Mailing Address - Street 1:2144 S HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4242
Mailing Address - Country:US
Mailing Address - Phone:626-968-5882
Mailing Address - Fax:626-968-0020
Practice Address - Street 1:2144 S HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-4242
Practice Address - Country:US
Practice Address - Phone:626-968-5882
Practice Address - Fax:626-968-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY21909Medicare UPIN
CAW18137Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
CA5027070002Medicare NSC