MEDICARE: DR. JINA YOO 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	DN013021	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN013021	OTHER		LICENSE

General Provider Information

NPI Number	:	1922163021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JINA YOO DDS

Provider Business Mailing Address
First Line	:	4375 COBB PKWY SE
Second Line	:	SUITE 110
City	:	ATLANTA
State	:	GA
Zip	:	30339-5536
Country	:	US
Telephone Number	:	770-541-9131
Fax Number	:	770-541-9132

Provider Business Practice Location Address
First Line	:	4375 COBB PKWY SE
Second Line	:	SUITE 110
City	:	ATLANTA
State	:	GA
Zip	:	30339-5536
Country	:	US
Telephone Number	:	770-541-9131
Fax Number	:	770-541-9132

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	03/07/2023

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