Healthcare Provider Details

I. General information

NPI: 1285892570
Provider Name (Legal Business Name): AMY YOUNGYEUN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 EAST BROADWAY BOONE HOSPITAL CENTER
COLUMBIA MO
65202
US

IV. Provider business mailing address

1600 EAST BROADWAY BOONE HOSPITAL CENTER
COLUMBIA MO
65202
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-6000
  • Fax: 573-815-8377
Mailing address:
  • Phone: 573-815-6000
  • Fax: 573-815-8377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR-8321
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2011023198
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: