=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821130238
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN S YOO O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 06/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9042 GARDEN GROVE BLVD STE 110
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92844-1370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-530-6611
-----------------------------------------------------
Fax | 714-415-5512
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9042 GARDEN GROVE BLVD STE 110
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92844-1370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-530-6611
-----------------------------------------------------
Fax | 714-415-5512
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 10099T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------