MEDICARE: CHARLIE JUNG HWAN YOO DO, MSC

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	207X00000X	Orthopaedic Surgery Physician	02007863A	IN
2	207X00000X	Orthopaedic Surgery Physician	OT019136	PA
3	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	102998	GA

General Provider Information

NPI Number	:	1649731043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLIE JUNG HWAN YOO DO, MSC

Provider Business Mailing Address
First Line	:	1285 HEMBREE RD STE 200A
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-4995
Country	:	US
Telephone Number	:	770-475-2710
Fax Number	:	770-475-0078

Provider Business Practice Location Address
First Line	:	1285 HEMBREE RD STE 200A
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-4995
Country	:	US
Telephone Number	:	770-475-2710
Fax Number	:	770-475-0078

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

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	06/25/2025

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