Provider Demographics
NPI:1255428215
Name:YOO, SANG BAK (MD)
Entity type:Individual
Prefix:DR
First Name:SANG
Middle Name:BAK
Last Name:YOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5451 LA PALMA AVE
Mailing Address - Street 2:SUITE 48
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1728
Mailing Address - Country:US
Mailing Address - Phone:714-523-8556
Mailing Address - Fax:714-994-0217
Practice Address - Street 1:5451 LA PALMA AVE
Practice Address - Street 2:SUITE 48
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1728
Practice Address - Country:US
Practice Address - Phone:714-523-8556
Practice Address - Fax:714-994-0217
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA337440207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337440Medicare ID - Type UnspecifiedMEDICARE PROVIDER MUNBER
CAA27239Medicare UPIN