Healthcare Provider Details

I. General information

NPI: 1124065099
Provider Name (Legal Business Name): ELISA K. YOO, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 KATELLA AVE SUITE 414
LOS ALAMITOS CA
90720-3338
US

IV. Provider business mailing address

3801 KATELLA AVE SUITE 414
LOS ALAMITOS CA
90720-3338
US

V. Phone/Fax

Practice location:
  • Phone: 562-430-9900
  • Fax: 562-430-6069
Mailing address:
  • Phone: 562-430-9900
  • Fax: 562-430-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA86311
License Number StateCA

VIII. Authorized Official

Name: ELISA K. YOO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-430-9900