Healthcare Provider Details

I. General information

NPI: 1154636876
Provider Name (Legal Business Name): PHILLIP B. YOO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12665 GARDEN GROVE BLVD STE 609
GARDEN GROVE CA
92843-1920
US

IV. Provider business mailing address

12665 GARDEN GROVE BLVD STE 609
GARDEN GROVE CA
92843-1920
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-2741
  • Fax: 714-636-2481
Mailing address:
  • Phone: 714-636-2741
  • Fax: 714-636-2481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC-31461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: