Provider Demographics
NPI:1801112461
Name:YOO, ERICA JEEWON (OD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:JEEWON
Last Name:YOO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 CENTURY PARK E
Mailing Address - Street 2:#408
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2244
Mailing Address - Country:US
Mailing Address - Phone:562-607-7890
Mailing Address - Fax:
Practice Address - Street 1:3537 TORRANCE BLVD
Practice Address - Street 2:SUITE 18
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4818
Practice Address - Country:US
Practice Address - Phone:562-607-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI704152W00000X
CA14118TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist