Provider Demographics
NPI:1750775300
Name:MICHAEL J YOO, MD INC
Entity type:Organization
Organization Name:MICHAEL J YOO, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PLASTIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-384-6308
Mailing Address - Street 1:22 ODYSSEY
Mailing Address - Street 2:SUITE 270A
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3186
Mailing Address - Country:US
Mailing Address - Phone:949-791-7941
Mailing Address - Fax:888-345-1631
Practice Address - Street 1:22 ODYSSEY
Practice Address - Street 2:SUITE 270A
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3186
Practice Address - Country:US
Practice Address - Phone:949-791-7941
Practice Address - Fax:888-345-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-21
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95823207YX0905X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty