Provider Demographics
NPI:1154072908
Name:YOO, KYUNG H (NP)
Entity Type:Individual
Prefix:
First Name:KYUNG
Middle Name:H
Last Name:YOO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 COPPER MOUNTAIN TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6218
Mailing Address - Country:US
Mailing Address - Phone:240-271-5127
Mailing Address - Fax:
Practice Address - Street 1:9055 CHEVROLET DR STE 205
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4000
Practice Address - Country:US
Practice Address - Phone:410-465-5451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220320363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care