Provider Demographics
NPI:1720519861
Name:WOO, GRACE (DO)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WOO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MACARTHUR PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707
Mailing Address - Country:US
Mailing Address - Phone:909-979-3195
Mailing Address - Fax:
Practice Address - Street 1:2 MACARTHUR PL
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707
Practice Address - Country:US
Practice Address - Phone:909-979-3195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2022-01-03
Deactivation Date:2021-12-15
Deactivation Code:
Reactivation Date:2021-12-30
Provider Licenses
StateLicense IDTaxonomies
CA20A16822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine