MEDICARE: DR. JIN YOO DDS

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	1223G0001X	General Practice Dentistry	50054158	NY
2	122300000X	Dentist	5005418	NY

General Provider Information

NPI Number	:	1972750552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIN YOO DDS

Provider Business Mailing Address
First Line	:	6809 242ND ST APT 2F
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362-2603
Country	:	US
Telephone Number	:	917-478-2902
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 UNION AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-3429
Country	:	US
Telephone Number	:	347-986-2032
Fax Number	:

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

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	06/02/2025

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