Provider Demographics
NPI:1811942493
Name:YOO, ELISA K (MD)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:K
Last Name:YOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3801 KATELLA AVE
Mailing Address - Street 2:SUITE 414
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3338
Mailing Address - Country:US
Mailing Address - Phone:562-430-9900
Mailing Address - Fax:562-430-6069
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:SUITE 414
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3338
Practice Address - Country:US
Practice Address - Phone:562-430-9900
Practice Address - Fax:562-430-6069
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA86311207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19753OtherPTAN
CAW19753OtherPTAN
H59297Medicare UPIN