MEDICARE: PAUL K. YOO D.O.

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	2081P0301X	Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician	25MB10611700	NJ
2	208100000X	Physical Medicine & Rehabilitation Physician	69861	MN

General Provider Information

NPI Number	:	1912325010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL K. YOO D.O.

Provider Business Mailing Address
First Line	:	2925 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1321
Country	:	US
Telephone Number	:	612-262-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	11850 BLACKFOOT ST NW STE 405
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-2773
Country	:	US
Telephone Number	:	763-236-0888
Fax Number	:

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

Provider Enumeration Date	:	04/04/2014
Last Update Date	:	08/05/2021

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