Healthcare Provider Details

I. General information

NPI: 1578674859
Provider Name (Legal Business Name): SIRIUS K. YOO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WELCH ROAD
STANFORD CA
94305-5739
US

IV. Provider business mailing address

16918 DOVE CANYON RD SUITE 208
SAN DIEGO CA
92127-3445
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-6500
  • Fax:
Mailing address:
  • Phone: 858-381-4801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA108402
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberML20007653
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: