Healthcare Provider Details

I. General information

NPI: 1851057079
Provider Name (Legal Business Name): CARROLLTON FIRST CARE MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 OLD DENTON RD STE 415
CARROLLTON TX
75007-5112
US

IV. Provider business mailing address

2625 OLD DENTON RD STE 415
CARROLLTON TX
75007-5112
US

V. Phone/Fax

Practice location:
  • Phone: 972-242-3361
  • Fax: 972-242-5678
Mailing address:
  • Phone: 972-242-3361
  • Fax: 972-242-5678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JONG YOO
Title or Position: OWNER
Credential: MD
Phone: 541-531-3990