MEDICARE: CARMEN JAN YOO, OD A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	11663T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063518181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARMEN JAN YOO, OD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1319 S HARBOR BLVD
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92832-3001
Country	:	US
Telephone Number	:	714-525-3330
Fax Number	:	714-525-3334

Provider Business Practice Location Address
First Line	:	1319 S HARBOR BLVD
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92832-3001
Country	:	US
Telephone Number	:	714-525-3330
Fax Number	:	714-525-3334

Authorized Official
Title or Position	:	CEO
Name	:	CARMEN JAN YOO
Credential	:	O.D.
Telephone Number	:	714-525-3330

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	05/06/2016

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