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NPI Code Detail

MEDICARE: JENNY Y YOO M.D.

MEDICARE: JENNY Y 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
1208600000XSurgery Physician4301094463MI
2208600000XSurgery Physician036141711IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1036141711OTHERILSTATE LICENSE

General Provider Information

NPI Number : 1912133836
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNY Y YOO M.D.
Provider Business Mailing Address
First Line : 4309 W MEDICAL CENTER DR STE B202
Second Line :
City : MCHENRY
State : IL
Zip : 60050-8417
Country : US
Telephone Number : 815-455-2752
Fax Number : 815-455-2789
Provider Business Practice Location Address
First Line : 4309 W MEDICAL CENTER DR STE B202
Second Line :
City : MCHENRY
State : IL
Zip : 60050-8417
Country : US
Telephone Number : 815-338-6600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2009
Last Update Date : 03/18/2019

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