MEDICARE: DR. MINJIN YOO DMD

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	390200000X	Student in an Organized Health Care Education/Training Program	12219	CT
2	1223P0221X	Pediatric Dentistry	22DI02885100	NJ

General Provider Information

NPI Number	:	1417450073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINJIN YOO DMD

Provider Business Mailing Address
First Line	:	405 KING GEORGE RD APT B-221
Second Line	:
City	:	BASKING RIDGE
State	:	NJ
Zip	:	07920-2812
Country	:	US
Telephone Number	:	202-999-7886
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 S MAIN ST STE G
Second Line	:
City	:	MARLBORO
State	:	NJ
Zip	:	07746-1578
Country	:	US
Telephone Number	:	202-999-7886
Fax Number	:

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

Provider Enumeration Date	:	03/09/2018
Last Update Date	:	06/15/2022

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