Provider Demographics
NPI:1881785624
Name:KEVIN YOO, M.D. APC
Entity type:Organization
Organization Name:KEVIN YOO, M.D. APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-909-9033
Mailing Address - Street 1:9921 CARMEL MOUNTAIN RD
Mailing Address - Street 2:#190
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2813
Mailing Address - Country:US
Mailing Address - Phone:858-909-9033
Mailing Address - Fax:858-429-4009
Practice Address - Street 1:4150 REGENTS PARK ROW STE 325
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9102
Practice Address - Country:US
Practice Address - Phone:858-909-9033
Practice Address - Fax:858-429-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86513174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG86513OtherCA MEDICAL LICENSE NUMBER
CAP00410632OtherRAILROAD MEDICARE PIN
CADG0405OtherRAILROAD MEDICARE GROUP ID
CAP00410632OtherRAILROAD MEDICARE PIN
CAW17809Medicare PIN
CADG0405OtherRAILROAD MEDICARE GROUP ID