Healthcare Provider Details

I. General information

NPI: 1750711487
Provider Name (Legal Business Name): HEATHER YOO MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12462 PUTNAM ST STE 501
WHITTIER CA
90602
US

IV. Provider business mailing address

12462 PUTNAM ST STE 501
WHITTIER CA
90602-1049
US

V. Phone/Fax

Practice location:
  • Phone: 562-789-5439
  • Fax: 562-789-4443
Mailing address:
  • Phone: 562-789-5439
  • Fax: 562-789-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberPA51254
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-51254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: