MEDICARE: DR. YOOMI HEO DDS

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	1223P0221X	Pediatric Dentistry	059228-01	NY
2	1223P0221X	Pediatric Dentistry	22DI02678900	NJ

General Provider Information

NPI Number	:	1811378201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOOMI HEO DDS

Provider Business Mailing Address
First Line	:	65 JEFFERSON AVE
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07201-2474
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 JEFFERSON AVE
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07201-2474
Country	:	US
Telephone Number	:	908-469-9100
Fax Number	:

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

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	09/30/2020

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Directions to “ DR. YOOMI HEO DDS” Practice Location

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