Healthcare Provider Details

I. General information

NPI: 1245660141
Provider Name (Legal Business Name): JINWOO YOO M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12632 DEXTER AVE
DETROIT MI
48238-3340
US

IV. Provider business mailing address

12632 DEXTER AVE
DETROIT MI
48238-3340
US

V. Phone/Fax

Practice location:
  • Phone: 313-868-7700
  • Fax: 313-868-0303
Mailing address:
  • Phone: 313-868-7700
  • Fax: 313-868-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JINWOO YOO
Title or Position: DOCTOR
Credential: M.D.
Phone: 313-868-7700