Provider Demographics
NPI:1780214411
Name:KOO, ANGELA YOUNGLIM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:YOUNGLIM
Last Name:KOO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 CAMPUS POINT DRIVE
Mailing Address - Street 2:DEPARTMENT OF PHARMACY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121
Mailing Address - Country:US
Mailing Address - Phone:310-293-7947
Mailing Address - Fax:
Practice Address - Street 1:10010 CAMPUS POINT DR
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1518
Practice Address - Country:US
Practice Address - Phone:858-280-6734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA671201835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care