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NPI Code Detail

MEDICARE: TAE S. YOO M.D.

MEDICARE: TAE S. YOO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician140696NY

General Provider Information

NPI Number : 1003991241
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAE S. YOO M.D.
Provider Business Mailing Address
First Line : 171 PARK HILL AVE
Second Line :
City : YONKERS
State : NY
Zip : 10705-1419
Country : US
Telephone Number : 914-423-2320
Fax Number : 914-969-3643
Provider Business Practice Location Address
First Line : 6355 BROADWAY
Second Line :
City : BRONX
State : NY
Zip : 10471-2701
Country : US
Telephone Number : 718-796-4424
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 07/08/2007

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