MEDICARE: KIJEON 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
1	2084P0800X	Psychiatry Physician	239188	NY

General Provider Information

NPI Number	:	1417061300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIJEON YOO M.D.

Provider Business Mailing Address
First Line	:	998 CROOKED HILL RD
Second Line	:
City	:	WEST BRENTWOOD
State	:	NY
Zip	:	11717-1019
Country	:	US
Telephone Number	:	631-761-3535
Fax Number	:	631-761-3535

Provider Business Practice Location Address
First Line	:	28 ISLAND ST
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-4617
Country	:	US
Telephone Number	:	631-487-5241
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	11/23/2016

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