Provider Demographics
NPI:1982030508
Name:YOO, SUSIE SEUNGYEARN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:SEUNGYEARN
Last Name:YOO
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 1:149 S LINHAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2474
Mailing Address - Country:US
Mailing Address - Phone:714-392-3556
Mailing Address - Fax:
Practice Address - Street 1:200 W ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-2900
Practice Address - Country:US
Practice Address - Phone:714-992-4619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA69709OtherREGISTERED PHARMACIST