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General NPI Number Information
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NPI Number | 1639451800
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Entity Type | Organization
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Legal Business Name | JAE YONG YOO, M.D., INC
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 966 S WESTERN AVE SUITE 208
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City | LOS ANGELES
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State | CA
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Zip | 90006-1013
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Country | US
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Telephone | 323-731-2001
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Fax | 323-731-1482
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Provider Business Mailing Address
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Address Line | 966 S WESTERN AVE SUITE 208
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City | LOS ANGELES
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State | CA
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Zip | 90006-1013
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Country | US
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Telephone | 323-731-2001
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Fax | 323-731-1482
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SUNEE YOO
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Credential |
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Telephone | 213-590-8370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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