=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679870125
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD Y YOO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2011
-----------------------------------------------------
Last Update Date | 11/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3601 A ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19134-1043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-427-5292
-----------------------------------------------------
Fax | 215-427-4616
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 318 S JUNIPER ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-5818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-498-8240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | MD427332
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0120X
-----------------------------------------------------
Taxonomy Name | Pediatric Surgery Physician
-----------------------------------------------------
License Number | MT182098
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------