Basic Information
| Provider Information | |||||||||
| NPI: | 1164678850 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOO | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | YI | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | H | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 23550 HAWTHORNE BLVD | ||||||||
| Address2: | STE 220 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905054722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622223120 | ||||||||
| FaxNumber: | 3107842021 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 STEIN PLZ | ||||||||
| Address2: | 1-340 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108255000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 08/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 13562 | CA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | OPT135620 | 05 | CA | MEDICAID |