Healthcare Provider Details

I. General information

NPI: 1679695340
Provider Name (Legal Business Name): STEPHEN YOO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 BRIGHTON WAY SUITE 307
BEVERLY HILLS CA
90210-4714
US

IV. Provider business mailing address

9400 BRIGHTON WAY SUITE 307
BEVERLY HILLS CA
90210-4714
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-2310
  • Fax: 310-273-0314
Mailing address:
  • Phone: 310-273-2310
  • Fax: 310-273-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301082190
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA107821
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA107821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: