Healthcare Provider Details

I. General information

NPI: 1447571518
Provider Name (Legal Business Name): JANE YOUNG YOO MD, MPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 W 56TH ST STE 304-305
NEW YORK NY
10019-3831
US

IV. Provider business mailing address

162 W 56TH ST STE 304-305
NEW YORK NY
10019-3831
US

V. Phone/Fax

Practice location:
  • Phone: 646-844-0424
  • Fax: 646-344-1053
Mailing address:
  • Phone: 646-844-0424
  • Fax: 646-344-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number52761
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number262903
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number262903
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: