Healthcare Provider Details

I. General information

NPI: 1154072908
Provider Name (Legal Business Name): KYUNG H YOO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DISTILLERY RD STE 200
WESTMINSTER MD
21157-5344
US

IV. Provider business mailing address

10 DISTILLERY RD STE 200
WESTMINSTER MD
21157-5344
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-1478
  • Fax:
Mailing address:
  • Phone: 410-871-1478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR220320
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: