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NPI Code Detail

MEDICARE: EUNG JAE YOO MD, PHD

MEDICARE: EUNG JAE YOO MD, PHD
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
1207R00000XInternal Medicine Physician35.144374OH

General Provider Information

NPI Number : 1841795267
Entity Type Code : Individual
Provider Name (Legal Business Name) : EUNG JAE YOO MD, PHD
Provider Business Mailing Address
First Line : 14601 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-4205
Country : US
Telephone Number : 216-237-5500
Fax Number :
Provider Business Practice Location Address
First Line : 14601 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-4205
Country : US
Telephone Number : 216-237-5500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2018
Last Update Date : 08/11/2022

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