Healthcare Provider Details

I. General information

NPI: 1912849431
Provider Name (Legal Business Name): SAMUEL YOO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 S CENTRAL AVE
LOS ANGELES CA
90011-5527
US

IV. Provider business mailing address

25020A PROSPECT AVE
LOMA LINDA CA
92354-2900
US

V. Phone/Fax

Practice location:
  • Phone: 323-234-5000
  • Fax: 323-231-3985
Mailing address:
  • Phone: 916-899-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: