MEDICARE: ANGEL S YOO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	814204	IL

General Provider Information

NPI Number	:	1477827855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL S YOO

Provider Business Mailing Address
First Line	:	1332 ELM PARK ST
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4504
Country	:	US
Telephone Number	:	818-532-8418
Fax Number	:

Provider Business Practice Location Address
First Line	:	1332 ELM PARK ST
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4504
Country	:	US
Telephone Number	:	818-532-8418
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	03/02/2012

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Directions to “ ANGEL S YOO ” Practice Location

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