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General NPI Number Information
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NPI Number | 1912141441
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Entity Type | Organization
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Legal Business Name | CARMEN JAN YOO
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 15057 GOLDENWEST ST
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-2710
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Country | US
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Telephone | 714-894-5556
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Fax | 714-895-3126
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Provider Business Mailing Address
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Address Line | 15057 GOLDENWEST ST
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-2710
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Country | US
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Telephone | 714-894-5556
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Fax | 714-895-3126
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARMEN JAN YOO
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Credential | O. D.
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Telephone | 714-894-5556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11663TPL
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License Number State | CA
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