MEDICARE: JAE YONG YOO, M.D., INC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1639451800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAE YONG YOO, M.D., INC

Provider Business Mailing Address
First Line	:	966 S WESTERN AVE
Second Line	:	SUITE 208
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-1013
Country	:	US
Telephone Number	:	323-731-2001
Fax Number	:	323-731-1482

Provider Business Practice Location Address
First Line	:	966 S WESTERN AVE
Second Line	:	SUITE 208
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-1013
Country	:	US
Telephone Number	:	323-731-2001
Fax Number	:	323-731-1482

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SUNEE YOO
Credential	:
Telephone Number	:	213-590-8370

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	09/14/2011

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