Healthcare Provider Details

I. General information

NPI: 1336074301
Provider Name (Legal Business Name): JEONG BIN YOO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 PHILOMENA ST
AUSTIN TX
78723-3574
US

IV. Provider business mailing address

324 FRANKLIN DR
PLACENTIA CA
92870-5012
US

V. Phone/Fax

Practice location:
  • Phone: 737-434-2436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: