Individual provider Active NPI

Paul Byoungjae Yoo, O.D

  • Optometrist
  • Anaheim, CA
National Provider Identifier
1417934316
Registry record updated Oct 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT-110408LTG Issued in CA
Practice address
1150 N Harbor Blvd
Suite 118
Anaheim, CA 92801-2400
Phone
(714) 758-0185
Fax
(714) 758-0759
NPI assigned
Dec 30, 2005
Last updated
Oct 20, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT-110408LTG CA Primary
Optometrist 152W00000X OPT11408T CA

Addresses

Primary practice location

1150 N Harbor Blvd
Suite 118
Anaheim, CA 92801-2400

Mailing address

1150 N. Harbor Blvd
Suite 118
Anaheim, CA 92801-2400
Phone (714) 758-0185

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT-110408LTGCAMDOptometrist
OPT11408TCAMDOptometrist
11408CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carmen Jan Yoo, OD a Professional Corporation Optometrist Past Accepting new patients
Equinox Home Care, Inc. PastSince Apr 10, 2019 Accepting new patients
Vision Plus Medical Group Past Accepting new patients
Carmen Jan Yoo Optometrist Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287532800000",
    "number": "1417934316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 N. HARBOR BLVD",
            "address_2": "SUITE 118",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012400",
            "telephone_number": "714-758-0185",
            "fax_number": "714-758-0759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N HARBOR BLVD",
            "address_2": "SUITE 118",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012400",
            "telephone_number": "714-758-0185",
            "fax_number": "714-758-0759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOO",
        "first_name": "PAUL",
        "middle_name": "BYOUNGJAE",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-30",
        "last_updated": "2010-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT-110408LTG",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT11408T",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.