Healthcare Provider Details

I. General information

NPI: 1740976760
Provider Name (Legal Business Name): JAE YOU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL BUILDING 3030
APO AP
96205-0054
US

IV. Provider business mailing address

1 JARRETT WHITE RD
TRIPLER AMC HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-2273
  • Fax:
Mailing address:
  • Phone: 845-764-2343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81690-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: