MEDICARE: DR. BYUNG SUN YOO DDS

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	122300000X	Dentist	43511	CA

General Provider Information

NPI Number	:	1497905475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BYUNG SUN YOO DDS

Provider Business Mailing Address
First Line	:	2425 3RD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-1515
Country	:	US
Telephone Number	:	619-231-1624
Fax Number	:	619-231-4455

Provider Business Practice Location Address
First Line	:	2425 3RD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-1515
Country	:	US
Telephone Number	:	619-231-1624
Fax Number	:	619-231-4455

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

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	09/25/2008

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