Provider Demographics
NPI:1588754675
Name:YOO, KYUNG SOO (MD)
Entity type:Individual
Prefix:
First Name:KYUNG
Middle Name:SOO
Last Name:YOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15446 PARTHENIA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-5108
Mailing Address - Country:US
Mailing Address - Phone:818-891-1616
Mailing Address - Fax:818-895-2706
Practice Address - Street 1:15446 PARTHENIA ST
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5108
Practice Address - Country:US
Practice Address - Phone:818-891-1616
Practice Address - Fax:818-895-2706
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA444720207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A444720Medicaid
CAF18425Medicare UPIN