Healthcare Provider Details

I. General information

NPI: 1205018918
Provider Name (Legal Business Name): ROY HYUNCHANG YOO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9242 WALKER ST STE C
CYPRESS CA
90630-3169
US

IV. Provider business mailing address

9242 WALKER ST STE C
CYPRESS CA
90630-3169
US

V. Phone/Fax

Practice location:
  • Phone: 714-220-2003
  • Fax: 714-220-2004
Mailing address:
  • Phone: 714-220-2003
  • Fax: 714-220-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number53303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: