Healthcare Provider Details

I. General information

NPI: 1982918082
Provider Name (Legal Business Name): COMFORT MED SHUTTLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CHARTHOUSE CV
BUENA PARK CA
90621-1663
US

IV. Provider business mailing address

11 CHARTHOUSE CV
BUENA PARK CA
90621-1663
US

V. Phone/Fax

Practice location:
  • Phone: 714-522-1177
  • Fax: 714-522-1177
Mailing address:
  • Phone: 714-522-1177
  • Fax: 714-522-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number8Y42009
License Number StateCA

VIII. Authorized Official

Name: MR. MICKLE YANGHEE YOO
Title or Position: OWNER
Credential:
Phone: 714-522-1177