Provider Demographics
NPI:1114364338
Name:YOO, KATE NIEHOFF (MD)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:NIEHOFF
Last Name:YOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATE
Other - Middle Name:ELIZABETH
Other - Last Name:NIEHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:45 SYCAMORE AVE APT 135
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6713
Mailing Address - Country:US
Mailing Address - Phone:410-440-3672
Mailing Address - Fax:
Practice Address - Street 1:45 SYCAMORE AVE APT 135
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:410-440-3672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD51740207Q00000X
PAMD456598207Q00000X
PAMT203568390200000X
CAA140342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program