MEDICARE: JENNIFER YOON RD

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	133V00000X	Registered Dietitian	DN003603	PA

General Provider Information

NPI Number	:	1740462258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER YOON RD

Provider Business Mailing Address
First Line	:	1580 MCLAUGHLIN RUN ROAD
Second Line	:	SUITE 208 PEDIATRIC ALLIANCE - ST. CLAIR DIVISION
City	:	PITTSBURGH
State	:	PA
Zip	:	15241
Country	:	US
Telephone Number	:	412-221-2121
Fax Number	:	412-221-7224

Provider Business Practice Location Address
First Line	:	1580 MCLAUGHLIN RUN ROAD
Second Line	:	SUITE 208 PEDIACTRIC ALLIANCE - ST. CLAIR
City	:	PITTSBURGH
State	:	PA
Zip	:	15241
Country	:	US
Telephone Number	:	412-221-2121
Fax Number	:	412-221-7224

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

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	11/27/2007

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