Provider Demographics
NPI:1114033347
Name:YOO, YOUNG (DC)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:
Last Name:YOO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 BUFORD HWY
Mailing Address - Street 2:STE L
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-2537
Mailing Address - Country:US
Mailing Address - Phone:770-242-9600
Mailing Address - Fax:770-242-9621
Practice Address - Street 1:5730 BUFORD HWY
Practice Address - Street 2:STE L
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2537
Practice Address - Country:US
Practice Address - Phone:770-242-9600
Practice Address - Fax:770-242-9621
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA458594Medicare UPIN
GAGRP7156Medicare ID - Type UnspecifiedPRACTICE GROUP NUMBER
GA35ZCDCSMedicare ID - Type UnspecifiedPROVIDER NUMBER