MEDICARE: DR. JADEN YOO DPT

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	225100000X	Physical Therapist	298170	CA
2	225100000X	Physical Therapist	016008	GA

General Provider Information

NPI Number	:	1467066654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JADEN YOO DPT

Provider Business Mailing Address
First Line	:	1902 CORTE TORERO
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-6531
Country	:	US
Telephone Number	:	949-812-2662
Fax Number	:

Provider Business Practice Location Address
First Line	:	1902 CORTE TORERO
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-6531
Country	:	US
Telephone Number	:	949-812-2662
Fax Number	:

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

Provider Enumeration Date	:	09/03/2020
Last Update Date	:	05/15/2023

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