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General NPI Number Information
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NPI Number | 1902314834
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Entity Type | Individual
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Provider Name | JAE YOUNG YOO DDS, MSD
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Gender | Male
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Dates
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Enumeration Date | 01/12/2018
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 14021 MIDLAND RD
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City | POWAY
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State | CA
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Zip | 92064-3959
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Country | US
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Telephone | 858-883-4860
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Fax | 858-883-4845
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Provider Business Mailing Address
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Address Line | 14021 MIDLAND RD
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City | POWAY
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State | CA
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Zip | 92064-3959
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Country | US
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Telephone | 858-883-4860
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Fax | 858-883-4845
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 00203357
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 103617
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License Number State | CA
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