Healthcare Provider Details

I. General information

NPI: 1932111614
Provider Name (Legal Business Name): JONG HYEON YOO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 03/18/2023
Certification Date: 03/18/2023
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 TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301081721
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS1021
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: