Healthcare Provider Details

I. General information

NPI: 1083678064
Provider Name (Legal Business Name): JINNY K YOO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EAST ST SE SUITE 301
VIENNA VA
22180-4800
US

IV. Provider business mailing address

100 EAST ST SE SUITE 301
VIENNA VA
22180-4800
US

V. Phone/Fax

Practice location:
  • Phone: 703-938-5555
  • Fax: 703-319-8580
Mailing address:
  • Phone: 703-938-5555
  • Fax: 703-319-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101058218
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: