Healthcare Provider Details

I. General information

NPI: 1003477167
Provider Name (Legal Business Name): COMPREHENSIVE PODIATRIC CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21409 DEVONSHIRE ST STE 101
CHATSWORTH CA
91311-2935
US

IV. Provider business mailing address

21409 DEVONSHIRE ST STE 101
CHATSWORTH CA
91311-2935
US

V. Phone/Fax

Practice location:
  • Phone: 818-527-1605
  • Fax: 818-979-8258
Mailing address:
  • Phone: 818-527-1605
  • Fax: 818-979-8258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: SEONG YOO
Title or Position: PRESIDENT
Credential: DPM
Phone: 310-434-0044