Provider Demographics
NPI:1134569437
Name:EDWARD YOO DDS INC
Entity type:Organization
Organization Name:EDWARD YOO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUK CHAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-723-8801
Mailing Address - Street 1:2809 G ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2133
Mailing Address - Country:US
Mailing Address - Phone:209-723-8801
Mailing Address - Fax:209-723-0255
Practice Address - Street 1:2809 G ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2133
Practice Address - Country:US
Practice Address - Phone:209-723-8801
Practice Address - Fax:209-723-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59859261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental